Healthcare Provider Details

I. General information

NPI: 1437476611
Provider Name (Legal Business Name): MAHATE ANN PARKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER DR
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER DR
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-3980
  • Fax: 580-421-6283
Mailing address:
  • Phone: 580-436-3980
  • Fax: 580-421-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27788
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: