Individual
MARK BLAINE MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
709 N CZECH HALL RD, YUKON, OK 73099-7897
(405) 494-8600
(405) 494-8567
Mailing address
800 FRISCO AVE, CLINTON, OK 73601-3306
(580) 323-2700
(580) 323-2276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20775
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107150C
—
OK
05
—
100107150D
—
OK
01
—
4436060740001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
07/13/2006
Last updated
04/07/2026
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