Individual
KEVIN WAYNE HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 S SAINTS BLVD STE 101, EDMOND, OK 73034-3082
(405) 513-8326
(405) 513-7739
Mailing address
101 S SAINTS BLVD STE 101, EDMOND, OK 73034-3082
(405) 513-8326
(405) 513-7739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16493
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100101900A
—
OK
Enumeration date
10/18/2005
Last updated
09/13/2019
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