Individual
KEVIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2100 W IOWA AVE, SUITE A, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2855
Mailing address
2100 W IOWA AVE, SUITE A, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4878
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200312900B
—
OK
Enumeration date
09/23/2009
Last updated
08/16/2016
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