Healthcare Provider Details

I. General information

NPI: 1265427140
Provider Name (Legal Business Name): DR. CARY COUCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N PERKINS RD
STILLWATER OK
74075-5513
US

IV. Provider business mailing address

320 N PERKINS RD
STILLWATER OK
74075-5513
US

V. Phone/Fax

Practice location:
  • Phone: 405-707-7500
  • Fax: 405-742-4990
Mailing address:
  • Phone: 405-707-7500
  • Fax: 405-742-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9237
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: