Kyle Fanning, MD | |
1401 Sw 34th St Ste 200, Moore, OK 73160-3059 | |
(405) 793-1188 | |
(405) 793-0492 |
Full Name | Kyle Fanning |
---|---|
Gender | Male |
Speciality | Family Practice |
Experience | 42 Years |
Location | 1401 Sw 34th St Ste 200, Moore, Oklahoma |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184668998 | NPI | - | NPPES |
100197770B | Medicaid | OK | |
100197770C | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 17631 (Oklahoma) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Integris Ambulatory Care Corporation | 2365408465 | 427 |
Entity Name | Integris Ambulatory Care Corporation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1750333936 PECOS PAC ID: 2365408465 Enrollment ID: O20041209000354 |
Mailing Address | Practice Location Address |
---|---|
Kyle Fanning, MD 5300 N Independence Ave, 280, Oklahoma City, OK 73112-5556 Ph: (405) 793-1188 | Kyle Fanning, MD 1401 Sw 34th St Ste 200, Moore, OK 73160-3059 Ph: (405) 793-1188 |
Nazanin Sara Hesami, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 320 N Service Rd, Moore, OK 73160 Phone: 405-794-4474 | |
Dr. Shelly Dawn Faubion, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 303 Se 4th St, Moore, OK 73160 Phone: 405-794-4664 Fax: 405-794-2853 | |
Nusrat Rumana, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2900 S Telephone Rd, Moore, OK 73160 Phone: 405-793-1188 | |
Dr. Sarah Elizabeth Cox, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1060 Sw 4th St, Moore, OK 73160 Phone: 405-378-5491 Fax: 405-378-5492 | |
Chandlar Maria Vazquez, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1060 Sw 4th St, Moore, OK 73160 Phone: 405-378-5491 Fax: 405-378-5492 | |
Dawna Mccreight, D.O. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 1227 N Santa Fe Ave, Moore, OK 73160 Phone: 405-799-4436 Fax: 405-793-1546 |