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General NPI Number Information
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NPI Number | 1578630224
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Entity Type | Organization
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Legal Business Name | OCA MUSTANG LP
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 SOUTH MUSTANG ROAD
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-324-1911
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Fax | 405-799-7033
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Provider Business Mailing Address
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Address Line | 301 SOUTH MUSTANG ROAD
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 405-324-1911
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Fax | 405-799-7033
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEVIN C CONATSER
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Credential | DO
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Telephone | 405-799-6500
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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 | 3562
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License Number State | OK
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