Basic Information
| Provider Information | |||||||||
| NPI: | 1568722817 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK 5 CARE GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9801 S MUSTANG RD | ||||||||
| Address2: | |||||||||
| City: | MUSTANG | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730649531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058306673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1407 N ROBINSON AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731034823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052328000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 05/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | RADER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4058306673 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 16912 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.