Provider Information for 1063619286
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Mr. MIKE DON DYSON M.S.P.S.
Sex: Male
NPI: 1063619286
Last Updated: 2010-02-02
Certification Date:
Certification Date:
Details
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NPI | 1063619286 | ||||||||
Enumeration Date | 2007-06-29 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 206 E. ROBERT S. KERR BLVD. WYNNEWOOD, OK 73098 United States Phone: | Fax: | ||||||||
Primary Practice Address | 202 S. WASHITA WYNNEWOOD, OK 73098 United States Phone: 405-665-4385 | Fax: | ||||||||
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