# DONEY MEDICAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104900554
- **Authorized official:** DR. JACK R. DONEY M.D. (PHYSICIAN)
- **Authorized official phone:** (918) 542-8477

## Contact information

- **Practice address:** 310 2ND AVE SW, SUITE 201, MIAMI, OK 74354-6702
- **Practice address phone:** (918) 542-8477
- **Practice address fax:** (918) 542-6422
- **Mailing address:** 310 2ND AVE SW, SUITE 201, MIAMI, OK 74354-6702
- **Mailing address phone:** (918) 542-8477
- **Mailing address fax:** (918) 542-6422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11653 | OK | — |
| 207V00000X | Obstetrics & Gynecology Physician | 11653 | OK | — |
| 261QM2500X | Medical Specialty Clinic/Center | 11653 | OK | Yes |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 04/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100209450A | — | OK |
| 05 | — | 100735640A | — | OK |