Provider Demographics
NPI:1043657844
Name:CAINE, AUGUSTUS L JR (MD)
Entity type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:L
Last Name:CAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12455 E 100TH ST N STE 260
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4676
Mailing Address - Country:US
Mailing Address - Phone:918-274-5560
Mailing Address - Fax:918-403-6336
Practice Address - Street 1:12455 E 100TH ST N STE 260
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4676
Practice Address - Country:US
Practice Address - Phone:918-274-5560
Practice Address - Fax:918-403-6336
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019014502207RC0000X
390200000X
OK39728207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program