Individual
KENNETH DEMASTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 NE 12TH ST, MOORE, OK 73160-5807
(405) 703-4202
Mailing address
6805 N WOODBROOK RD, WARR ACRES, OK 73132-6413
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1077
OK
Other
Enumeration date
10/24/2006
Last updated
05/29/2014
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