MEDICARE: KD FAMILY CARE CENTER 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
1	207Q00000X	Family Medicine Physician	4035	OK

General Provider Information

NPI Number	:	1952339558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KD FAMILY CARE CENTER PLLC

Provider Business Mailing Address
First Line	:	720 BRYAN DR
Second Line	:	SUITE A
City	:	DURANT
State	:	OK
Zip	:	74701-7032
Country	:	US
Telephone Number	:	580-931-8180
Fax Number	:	580-931-8015

Provider Business Practice Location Address
First Line	:	720 BRYAN DR
Second Line	:	SUITE A
City	:	DURANT
State	:	OK
Zip	:	74701-7032
Country	:	US
Telephone Number	:	405-745-7753
Fax Number	:	405-745-6798

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARIUS R NOBLE
Credential	:	D.O.
Telephone Number	:	580-931-8180

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/20/2007

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