Individual
DR. KEITH STACY PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10512 NORTH 110TH EAST AVENUE, OWASSO, OK 74055-6636
(918) 376-8900
(918) 272-7475
Mailing address
10512 N 110TH EAST AVE, OWASSO, OK 74055-6636
(918) 376-8900
(918) 376-8990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4322
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200091850A
—
OK
01
—
4322
LICENSE
OK
Enumeration date
08/01/2006
Last updated
05/06/2014
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