Provider Demographics
NPI:1437219383
Name:KENNETH F DUGGAN CRNA INC
Entity Type:Organization
Organization Name:KENNETH F DUGGAN CRNA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:580-924-3813
Mailing Address - Street 1:PO BOX 5188
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-5188
Mailing Address - Country:US
Mailing Address - Phone:580-924-3813
Mailing Address - Fax:580-924-0909
Practice Address - Street 1:1800 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3006
Practice Address - Country:US
Practice Address - Phone:580-924-3813
Practice Address - Fax:580-924-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0045503367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK367500000XOtherTAXONOMY CODE NUMBER
OK550564322001OtherBCBS
OK200109850AMedicaid
OKR0045503OtherLICENSE NUMBER
OK193400000XOtherSINGLE SPECIALITY GROUP TAXONOMY CODE
OK550564322001OtherBCBS
OK200109850AMedicaid