Provider Demographics
NPI:1669450821
Name:CONATSER, KEVIN C (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:CONATSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5823
Mailing Address - Country:US
Mailing Address - Phone:405-691-5208
Mailing Address - Fax:405-378-0556
Practice Address - Street 1:11601 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5823
Practice Address - Country:US
Practice Address - Phone:405-691-5208
Practice Address - Fax:405-378-0556
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG84038Medicare UPIN