Healthcare Provider Details

I. General information

NPI: 1922930510
Provider Name (Legal Business Name): MATTHEW DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E WYANDOTTE AVE
MCALESTER OK
74501-5427
US

IV. Provider business mailing address

735 S 3RD ST
MCALESTER OK
74501-5823
US

V. Phone/Fax

Practice location:
  • Phone: 918-420-5343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: