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NPI Code Detail

MEDICARE: MR. MARK C DENNEY PA

MEDICARE: MR. MARK C DENNEY PA
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
1363A00000XPhysician Assistant988OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200032585OTHEROKRAILROAD MEDICARE

General Provider Information

NPI Number : 1710958269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK C DENNEY PA
Provider Business Mailing Address
First Line : 3115 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7901
Country : US
Telephone Number : 405-424-5630
Fax Number : 405-652-1632
Provider Business Practice Location Address
First Line : 3115 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7901
Country : US
Telephone Number : 405-424-5630
Fax Number : 405-652-1632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 12/15/2008

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