Provider Demographics
NPI:1861826943
Name:KEVIN DUX DPM INC PC
Entity Type:Organization
Organization Name:KEVIN DUX DPM INC PC
Other - Org Name:MUSKOGEE INSTITUTE OF FOOT AND ANKLE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-681-4488
Mailing Address - Street 1:101 ROCKEFELLER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5056
Mailing Address - Country:US
Mailing Address - Phone:918-681-4488
Mailing Address - Fax:918-681-4499
Practice Address - Street 1:101 ROCKEFELLER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5056
Practice Address - Country:US
Practice Address - Phone:918-681-4488
Practice Address - Fax:918-681-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6961760001OtherMEDICARE NSC
OK6961760001Medicare Oscar/Certification
OK6961760001OtherMEDICARE NSC