Provider Demographics
NPI:1407198906
Name:DUGAN, STEVEN R (MANAGEMENT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:DUGAN
Suffix:
Gender:M
Credentials:MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26256 CAUGHRON RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932-2376
Mailing Address - Country:US
Mailing Address - Phone:918-647-7829
Mailing Address - Fax:918-654-3020
Practice Address - Street 1:1024 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4006
Practice Address - Country:US
Practice Address - Phone:918-647-7829
Practice Address - Fax:918-654-3020
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9186543020Medicare NSC