Provider Demographics
NPI:1548457286
Name:AMIE E PROUGH MD PLLC
Entity type:Organization
Organization Name:AMIE E PROUGH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-844-4300
Mailing Address - Street 1:1700 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3022
Mailing Address - Country:US
Mailing Address - Phone:405-844-4300
Mailing Address - Fax:405-844-4333
Practice Address - Street 1:1700 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3022
Practice Address - Country:US
Practice Address - Phone:405-844-4300
Practice Address - Fax:405-844-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty