Provider Demographics
NPI:1740329226
Name:MCCONATHY, ROBERT MASON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MASON
Last Name:MCCONATHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MASON
Other - Middle Name:
Other - Last Name:MCCONATHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:608 NW 9TH ST STE 6210
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1069
Mailing Address - Country:US
Mailing Address - Phone:405-272-9641
Mailing Address - Fax:405-235-0738
Practice Address - Street 1:608 NW 9TH ST STE 6210
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1069
Practice Address - Country:US
Practice Address - Phone:405-272-9641
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24007207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology