MEDICARE: MR. RONALD WAYNE SECOY PA-C

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
1	363A00000X	Physician Assistant	728	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427091826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD WAYNE SECOY PA-C

Provider Business Mailing Address
First Line	:	2220 W IOWA AVE
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2738
Country	:	US
Telephone Number	:	405-779-2721
Fax Number	:	405-779-2310

Provider Business Practice Location Address
First Line	:	113 S RUSH STREET
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-0277
Country	:	US
Telephone Number	:	580-476-2527
Fax Number	:	580-476-3707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/16/2016

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