Healthcare Provider Details

I. General information

NPI: 1265607212
Provider Name (Legal Business Name): RONNIE KEITH DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PALMER CIR
NORMAN OK
73069-6349
US

IV. Provider business mailing address

PO BOX 722796
NORMAN OK
73070-9123
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-7100
  • Fax:
Mailing address:
  • Phone: 405-360-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1923
License Number StateOK

VIII. Authorized Official

Name: AMANDA MCKINNON
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-360-7100