Provider Demographics
NPI:1407815368
Name:MCCRORY, RODNEY O (DO)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:O
Last Name:MCCRORY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3133
Mailing Address - Country:US
Mailing Address - Phone:405-395-4441
Mailing Address - Fax:405-438-0540
Practice Address - Street 1:2400 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3133
Practice Address - Country:US
Practice Address - Phone:405-395-4441
Practice Address - Fax:405-438-0540
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100134170AMedicaid
OK100134170AMedicaid