Organization
PARK PLACE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA RAYE COSBY MD (OWNER)
(405) 376-5439
Entity
Organization
Contact information
Practice address
500 PARK PL, MUSTANG, OK 73064-3104
(406) 376-5439
(405) 376-6459
Mailing address
500 PARK PL, MUSTANG, OK 73064-3104
(406) 376-5439
(405) 376-6459
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15742
OK
Other
Enumeration date
07/15/2014
Last updated
07/15/2014
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