Provider Demographics
NPI:1376528372
Name:CAUTHON, JOHN KEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEAN
Last Name:CAUTHON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 N HARVILLE RD
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:580-255-6600
Mailing Address - Fax:580-255-7887
Practice Address - Street 1:1314 N HARVILLE RD
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:580-255-6600
Practice Address - Fax:580-255-7887
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716640AMedicaid
OK100716640AMedicaid
OK0725250001Medicare NSC