Provider Demographics
NPI:1255652277
Name:MCCRACKEN, RYAN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 S MISSION ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4635
Mailing Address - Country:US
Mailing Address - Phone:918-347-6484
Mailing Address - Fax:918-216-4335
Practice Address - Street 1:615 S MISSION ST STE A
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4635
Practice Address - Country:US
Practice Address - Phone:918-347-6484
Practice Address - Fax:918-216-4335
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics