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Individual

MARK DOUGLAS FOSSEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1011 HONOR HEIGHTS DR, JACK C. MONTGOMERY VAMC, MUSKOGEE, OK 74401-1318
(918) 577-3031
Mailing address
PO BOX 21228, DEPARTMENT 31, TULSA, OK 74121-1228
(918) 491-3762
(918) 491-5740

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11793
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100118230A
OK
Enumeration date
01/26/2006
Last updated
03/20/2017
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