Provider Demographics
NPI:1093755803
Name:NAGODE, CORY D (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:D
Last Name:NAGODE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-425-8100
Mailing Address - Fax:405-425-8109
Practice Address - Street 1:1600 SW 119TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4908
Practice Address - Country:US
Practice Address - Phone:405-425-8100
Practice Address - Fax:405-425-8109
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-07-19
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Provider Licenses
StateLicense IDTaxonomies
OK15316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100736700QMedicaid
OK100736700QMedicaid
900522214Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
OK100736700QMedicaid