Healthcare Provider Details

I. General information

NPI: 1700839883
Provider Name (Legal Business Name): KATHY KERNEK DAGG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ROBINSON ST SUITE A 100
NORMAN OK
73071-6652
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE140
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-4644
  • Fax: 405-447-1061
Mailing address:
  • Phone: 405-752-3162
  • Fax: 405-936-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14425
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: