Provider Demographics
NPI:1063408656
Name:FAUBION, MITSI A (DO)
Entity type:Individual
Prefix:DR
First Name:MITSI
Middle Name:A
Last Name:FAUBION
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MILBURN
Mailing Address - State:OK
Mailing Address - Zip Code:73450-0067
Mailing Address - Country:US
Mailing Address - Phone:580-443-3533
Mailing Address - Fax:580-443-3536
Practice Address - Street 1:109 STANLEY RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OK
Practice Address - Zip Code:74536-0219
Practice Address - Country:US
Practice Address - Phone:918-569-4143
Practice Address - Fax:918-569-7343
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072150BMedicaid
OK243622901Medicare PIN
OKI44200Medicare UPIN
OK371839Medicare Oscar/Certification