Provider Demographics
NPI:1467765941
Name:MAYANK DAVE MDPC
Entity Type:Organization
Organization Name:MAYANK DAVE MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-678-7050
Mailing Address - Street 1:5606 SW LEE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5606 SW LEE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9689
Practice Address - Country:US
Practice Address - Phone:580-678-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty