Individual
DEACON VICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4200 S DOUGLAS AVE, SUITE 306, OKLAHOMA CITY, OK 73109-3223
(405) 636-7709
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5644
OK
Other
Enumeration date
01/03/2014
Last updated
08/21/2025
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