Provider Demographics
NPI:1528389376
Name:COREY E. MAYO D.O. PLLC
Entity Type:Organization
Organization Name:COREY E. MAYO D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA MS
Authorized Official - Phone:405-418-4505
Mailing Address - Street 1:13100 N WESTERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1431
Mailing Address - Country:US
Mailing Address - Phone:405-418-4500
Mailing Address - Fax:405-418-4501
Practice Address - Street 1:13100 N WESTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1431
Practice Address - Country:US
Practice Address - Phone:405-418-4500
Practice Address - Fax:405-418-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4862207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200292750AMedicaid
OKOKA100932Medicare PIN
OK6516930001Medicare NSC