Provider Demographics
NPI:1952499592
Name:MACKEY, WINONA R (MD)
Entity Type:Individual
Prefix:DR
First Name:WINONA
Middle Name:R
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:WINONA
Other - Middle Name:R
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6100
Mailing Address - Country:US
Mailing Address - Phone:580-536-2121
Mailing Address - Fax:
Practice Address - Street 1:104 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6100
Practice Address - Country:US
Practice Address - Phone:580-536-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK193282085R0001X
OK186672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200211660AMedicaid
OK701022Medicare PIN
F14737Medicare UPIN