Healthcare Provider Details

I. General information

NPI: 1518927664
Provider Name (Legal Business Name): JACK R. DONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW SUITE 201
MIAMI OK
74354-6702
US

IV. Provider business mailing address

310 2ND AVE SW SUITE 201
MIAMI OK
74354-6702
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-8477
  • Fax: 918-542-6422
Mailing address:
  • Phone: 918-542-8477
  • Fax: 918-542-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11653
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11653
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: