Provider Demographics
NPI:1235365669
Name:JOSEPH C MITRO, MD, PC
Entity Type:Organization
Organization Name:JOSEPH C MITRO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-470-9800
Mailing Address - Street 1:2115 DUNCAN REGIONAL LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1514
Mailing Address - Country:US
Mailing Address - Phone:580-470-9800
Mailing Address - Fax:580-470-9802
Practice Address - Street 1:2115 DUNCAN REGIONAL LOOP ROAD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1514
Practice Address - Country:US
Practice Address - Phone:580-470-9800
Practice Address - Fax:580-470-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100148540AMedicaid
OK249420201Medicare PIN