Unknown Individual – Family Medicine Physician, NPI 1619975950
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
400, Fairview Avenue, Ponca City, Kay County, Oklahoma, 74601, United States
SUITE 20
PONCA CITY, OK 746011920
Phone: (580) 765-6647
Fax: (580) 765-6699
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 74601)
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