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NPI Code Detail

MEDICARE: CORNERSTONE FAMILY MEDICINE PLLC

MEDICARE: CORNERSTONE FAMILY MEDICINE PLLC
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 Physician

General Provider Information

NPI Number : 1376257832
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNERSTONE FAMILY MEDICINE PLLC
Provider Business Mailing Address
First Line : 3100 DOWNS AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-5328
Country : US
Telephone Number : 580-254-5316
Fax Number : 580-254-0130
Provider Business Practice Location Address
First Line : 4902 OKLAHOMA AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-3713
Country : US
Telephone Number : 580-254-5316
Fax Number : 580-254-0130
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : KEENAN FERGUSON
Credential : DO
Telephone Number : 580-254-5316
Provider Enumeration Date : 01/10/2023
Last Update Date : 01/10/2023

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Directions to “CORNERSTONE FAMILY MEDICINE PLLC ” Practice Location

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