Facts
- Status
- A
- Credential
- DO
- Type
- Individual
- Enumeration date
- 2006-01-13
- Last updated
- 2025-09-29
Licenses
- License OK
- 3932
- License AZ
- 007531
- License OK
- 3932
Location
- Practice location
- 709 N CZECH HALL RD
- City
- YUKON OK
- Postal code
- 730997897
- Phone
- 405-494-8600
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.