Provider Demographics
NPI:1780901694
Name:DUX, KEVIN RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RICHARD
Last Name:DUX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 ROCKEFELLER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5056
Mailing Address - Country:US
Mailing Address - Phone:918-681-4488
Mailing Address - Fax:918-681-4499
Practice Address - Street 1:101 ROCKEFELLER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5056
Practice Address - Country:US
Practice Address - Phone:918-681-4488
Practice Address - Fax:918-681-4499
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK302213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery