Provider Demographics
NPI:1811972581
Name:DAVID L KYGER MD PC
Entity type:Organization
Organization Name:DAVID L KYGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:KYGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-682-2481
Mailing Address - Street 1:3332 W OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-682-2481
Mailing Address - Fax:918-682-2932
Practice Address - Street 1:3332 WEST OKMULGEE STREET
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-682-2481
Practice Address - Fax:918-682-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
730929415001OtherBLUE CROSS BLUE SHIELD
110236658OtherRR MEDICARE
OK100122200BMedicaid
OK100122200BMedicaid
730929415001OtherBLUE CROSS BLUE SHIELD