Marvin Moul

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5887 Issued in OK

Practice address

104 Lone Oak Cir
Fort Gibson, OK 74434-5001

Phone

(918) 478-2101

NPI assigned

Aug 24, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1811180664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LONE OAK CIRCLE",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "74434",
            "telephone_number": "918-478-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LONE OAK CIR",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "744345001",
            "telephone_number": "918-478-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUL",
        "first_name": "MARVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "5887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn McComb
• Lauren Means, DDS
• Susan Marie Miller, FNP-C
• Alec Moreno
• Aubree Morton, CF-SLP
• Nicholas Mullen
• Michael John Nelson, D.D.S
• Northeastern Health System (Fort Gibson Medical Clinic)
• Ok4 Ft. Gibson Opco LLC (Fort Gibson Nursing Center)
• Ann Elizabeth Page, D.C.

• Internal Medicine Physician in Fort Gibson, OK
• Providers in Fort Gibson, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.