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General NPI Number Information
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NPI Number | 1356790133
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Entity Type | Individual
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Provider Name | MARK ROSEKELLY D.O
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Gender | Male
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 4086 COUNTRY CLUB RD STE 2
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City | DUNCAN
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State | OK
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Zip | 73533-5580
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Country | US
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Telephone | 580-952-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 4086 COUNTRY CLUB RD STE 2
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City | DUNCAN
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State | OK
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Zip | 73533-5580
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Country | US
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Telephone | 580-952-9221
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Fax | 616-207-0558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6915
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License Number State | OK
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