Individual
DR. KENNY M. GRIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1805 W UNIVERSITY BLVD, DURANT, OK 74701-3011
(580) 920-0300
(580) 920-0581
Mailing address
1805 W UNIVERSITY BLVD, DURANT, OK 74701-3011
(580) 920-0300
(580) 920-0581
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
DO3262
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100136800A
—
OK
01
—
200022524
RAILROAD MEDICARE
OK
Enumeration date
12/21/2005
Last updated
09/15/2020
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