Provider Demographics
NPI:1851356570
Name:MALOY, CYNTHIA (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MALOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12455E 100TH N ST 350
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4675
Mailing Address - Country:US
Mailing Address - Phone:918-274-5510
Mailing Address - Fax:918-403-6312
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:SUITE 120
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4674
Practice Address - Country:US
Practice Address - Phone:918-274-5510
Practice Address - Fax:918-274-5519
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100094220AMedicaid
OK100094220AMedicaid