George Leonard Ettel III, DO

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

7050 Air Depot Blvd BLDG 1094
Tinker AFB, OK 73145-8716

Phone

(727) 667-0390

Fax

(405) 736-3619

NPI assigned

Mar 26, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1861029076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W HIGHLAND BLVD",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7050 AIR DEPOT BLVD BLDG 1094",
            "city": "TINKER AFB",
            "state": "OK",
            "postal_code": "731458716",
            "telephone_number": "727-667-0390",
            "fax_number": "405-736-3619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTEL",
        "first_name": "GEORGE",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Inverness",
            "affiliation": "N",
            "address_1": "502 W Highland Blvd",
            "city": "Inverness",
            "state": "FL",
            "country_code": "US",
            "postal_code": "344524720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Department of the Air Force 72D Medical Group (DoD TINKER ePhcy)
• James Neal Dillard III, PA-C
• Robert Christopher Dunn, MD
• Stephen Ryan Emmerthal
• Peter Mitchell Estrada, DAT, LAT, ATC, BCS-O
• Audra Feisal, LCSW
• Misty Spring Evelyn Foley-McKenna, LCSW
• Shaylee Jade Fouts, MED, ATC, LAT, PES
• Stacey Anne Frazier, MD
• Clayton Franklin Fuqua, MD

• Military Health Care Provider in Tinker AFB, OK
• Providers in Tinker AFB, OK by specialty
• Military Health Care Provider in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.