Healthcare Provider Details

I. General information

NPI: 1528389376
Provider Name (Legal Business Name): COREY E. MAYO D.O. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

IV. Provider business mailing address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-4500
  • Fax: 405-418-4501
Mailing address:
  • Phone: 405-418-4500
  • Fax: 405-418-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4862
License Number StateOK

VIII. Authorized Official

Name: RANDALL MURRAY
Title or Position: ADMINISTRATOR
Credential: BSBA MS
Phone: 405-418-4505