Provider Demographics
NPI:1750097697
Name:MAYES, DONALD JENE SR (SURGICAL TECH)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JENE
Last Name:MAYES
Suffix:SR
Gender:M
Credentials:SURGICAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 MAXEY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1101
Mailing Address - Country:US
Mailing Address - Phone:918-616-4410
Mailing Address - Fax:
Practice Address - Street 1:1402 MAXEY DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1101
Practice Address - Country:US
Practice Address - Phone:918-616-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant