Organization Name: | ROGER L KINNEY MD PC |
NPI Number: | 1548449374 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROGER L KINNEY (PHYSICIAN) |
Mailing Address: | 27 N Main St Sapulpa |
State: | OK US |
Postal Code: | 740663901 |
Phone Number: | 9182485393 |
Fax Number: | 9182485399 |
NPI Enumeration Date: | 10/29/2007 |
NPI Last Update Date: | 10/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |