MEDICARE: MARK EDWARD RIGNEY M.D.

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	207Q00000X	Family Medicine Physician	22078	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
2	7029546	OTHER		AETNA

General Provider Information

NPI Number	:	1447253737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EDWARD RIGNEY M.D.

Provider Business Mailing Address
First Line	:	425 FAIRVIEW AVE STE 1
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1924
Country	:	US
Telephone Number	:	580-765-6647
Fax Number	:	580-765-6699

Provider Business Practice Location Address
First Line	:	425 FAIRVIEW AVE STE 1
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1924
Country	:	US
Telephone Number	:	580-765-6647
Fax Number	:	580-765-6699

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/07/2021

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