Healthcare Provider Details

I. General information

NPI: 1831553817
Provider Name (Legal Business Name): MEDOK MUSTANG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 S MUSTANG RD
YUKON OK
73099-0304
US

IV. Provider business mailing address

1616 S MUSTANG RD
YUKON OK
73099-0304
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-0501
  • Fax:
Mailing address:
  • Phone: 405-256-0501
  • Fax: 405-265-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DERRICK FREEMAN
Title or Position: OWNER
Credential: DO
Phone: 405-256-0501