=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265607212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONNIE KEITH DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 01/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2405 PALMER CIR
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-360-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 722796
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73070-9123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-360-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | AMANDA MCKINNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-360-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 1923
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------