Healthcare Provider Details

I. General information

NPI: 1376762757
Provider Name (Legal Business Name): K E WHINERY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTH WATTS
SAYRE OK
73662
US

IV. Provider business mailing address

RR 4 BOX 131
SAYRE OK
73662-9301
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-7073
  • Fax: 402-434-6047
Mailing address:
  • Phone: 402-486-7073
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH E WHINERY
Title or Position: OWNER
Credential: MD
Phone: 402-486-7073