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NPI Code Detail

MEDICARE: DR. HENRY KEITH BOREN D.O.

MEDICARE: DR. HENRY KEITH BOREN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2255OK
22083A0100XAerospace Medicine Physician2255OK

General Provider Information

NPI Number : 1205849767
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY KEITH BOREN D.O.
Provider Business Mailing Address
First Line : 527 W 3RD ST
Second Line :
City : KONAWA
State : OK
Zip : 74849-1415
Country : US
Telephone Number : 580-925-3286
Fax Number : 580-925-2362
Provider Business Practice Location Address
First Line : 905 COLONY DR
Second Line :
City : ADA
State : OK
Zip : 74820-2329
Country : US
Telephone Number : 580-436-5111
Fax Number : 580-436-1159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 02/19/2026

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Directions to “ DR. HENRY KEITH BOREN D.O.” Practice Location

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