Healthcare Provider Details

I. General information

NPI: 1952339558
Provider Name (Legal Business Name): KD FAMILY CARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BRYAN DR SUITE A
DURANT OK
74701-7032
US

IV. Provider business mailing address

720 BRYAN DR SUITE A
DURANT OK
74701-7032
US

V. Phone/Fax

Practice location:
  • Phone: 405-745-7753
  • Fax: 405-745-6798
Mailing address:
  • Phone: 580-931-8180
  • Fax: 580-931-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4035
License Number StateOK

VIII. Authorized Official

Name: DR. DARIUS R NOBLE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 580-931-8180