Healthcare Provider Details

I. General information

NPI: 1710198569
Provider Name (Legal Business Name): MARK A DAWKINS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13174 N MACARTHUR BLVD
OKLAHOMA CITY OK
73142-3017
US

IV. Provider business mailing address

DEPT 96-0317
OKLAHOMA CITY OK
73196-0317
US

V. Phone/Fax

Practice location:
  • Phone: 405-721-5555
  • Fax: 405-470-7093
Mailing address:
  • Phone: 405-521-1969
  • Fax: 405-521-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19539
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A DAWKINS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 405-721-5555