Provider Demographics
NPI:1689652075
Name:NOKES, PHILLIP ALTON (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALTON
Last Name:NOKES
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 1:3062 FOXDEN RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7751
Mailing Address - Country:US
Mailing Address - Phone:580-657-2587
Mailing Address - Fax:
Practice Address - Street 1:1105 MICHELIN RD
Practice Address - Street 2:MICHELIN FAMILY HEALTH CENTER
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1085
Practice Address - Country:US
Practice Address - Phone:580-224-8750
Practice Address - Fax:580-224-4454
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1919207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123410AMedicaid
OK100123410AMedicaid