Healthcare Provider Details

I. General information

NPI: 1578550851
Provider Name (Legal Business Name): MARK R STOREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/13/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

V. Phone/Fax

Practice location:
  • Phone: 405-773-6700
  • Fax:
Mailing address:
  • Phone: 405-773-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberE2669
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: