Healthcare Provider Details

I. General information

NPI: 1043657844
Provider Name (Legal Business Name): AUGUSTUS L CAINE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 E 100TH ST N STE 260
OWASSO OK
74055-4676
US

IV. Provider business mailing address

12455 E 100TH ST N STE 260
OWASSO OK
74055-4676
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-5560
  • Fax: 918-403-6336
Mailing address:
  • Phone: 918-274-5560
  • Fax: 918-403-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2019014502
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number39728
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: