Healthcare Provider Details

I. General information

NPI: 1861826943
Provider Name (Legal Business Name): KEVIN DUX DPM INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 06/04/2014
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOK

VIII. Authorized Official

Name: KEVIN DUX
Title or Position: OWNER
Credential: DPM
Phone: 918-681-4488