Provider Demographics
NPI:1952339558
Name:KD FAMILY CARE CENTER PLLC
Entity Type:Organization
Organization Name:KD FAMILY CARE CENTER PLLC
Other - Org Name:FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-931-8180
Mailing Address - Street 1:720 BRYAN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7032
Mailing Address - Country:US
Mailing Address - Phone:580-931-8180
Mailing Address - Fax:580-931-8015
Practice Address - Street 1:720 BRYAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7032
Practice Address - Country:US
Practice Address - Phone:405-745-7753
Practice Address - Fax:405-745-6798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty