Provider Demographics
NPI:1104086321
Name:MANKIN, ALICE JOY (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:JOY
Last Name:MANKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MANKIN
Other - Last Name:LAMASCUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8556
Mailing Address - Country:US
Mailing Address - Phone:405-757-3365
Mailing Address - Fax:405-757-3498
Practice Address - Street 1:2017 W I 35 FRONTAGE RD STE 150
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8556
Practice Address - Country:US
Practice Address - Phone:405-757-3365
Practice Address - Fax:405-757-3498
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine