Individual
DR. MARK ALLEN BIRDSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10512 N 110TH EAST AVE, SUITE 240, OWASSO, OK 74055-6636
(918) 212-1200
(918) 212-1201
Mailing address
10512 N 110TH EAST AVE, SUITE 240, OWASSO, OK 74055-6636
(918) 212-1200
(918) 212-1201
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
26563
OK
208600000X
Surgery Physician
94-05976
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200203050A
—
OK
Enumeration date
04/04/2007
Last updated
06/24/2014
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