Healthcare Provider Details

I. General information

NPI: 1578630224
Provider Name (Legal Business Name): OCA MUSTANG LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOUTH MUSTANG ROAD
YUKON OK
73099
US

IV. Provider business mailing address

301 SOUTH MUSTANG ROAD
YUKON OK
73099
US

V. Phone/Fax

Practice location:
  • Phone: 405-324-1911
  • Fax: 405-799-7033
Mailing address:
  • Phone: 405-324-1911
  • Fax: 405-799-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3562
License Number StateOK

VIII. Authorized Official

Name: DR. KEVIN C CONATSER
Title or Position: PHYSICIAN
Credential: DO
Phone: 405-799-6500