Healthcare Provider Details

I. General information

NPI: 1780901694
Provider Name (Legal Business Name): KEVIN RICHARD DUX DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROCKEFELLER DR SUITE 204
MUSKOGEE OK
74401-5056
US

IV. Provider business mailing address

101 ROCKEFELLER DR SUITE 204
MUSKOGEE OK
74401-5056
US

V. Phone/Fax

Practice location:
  • Phone: 918-681-4488
  • Fax: 918-681-4499
Mailing address:
  • Phone: 918-681-4488
  • Fax: 918-681-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number302
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number302
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: