MEDICARE: DOCOK1

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1497398671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCOK1

Provider Business Mailing Address
First Line	:	5040 ADDISON CIR STE 400
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-6049
Country	:	US
Telephone Number	:	214-983-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 SW 89TH ST STE 200E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7908
Country	:	US
Telephone Number	:	405-673-3280
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PRACTICE DEVELOPMENT
Name	:	DANIELLE LEMOINE MAXWELL
Credential	:
Telephone Number	:	214-983-0303

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/21/2019

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