Provider Demographics
NPI:1124256888
Name:DAMON, MARK II (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAMON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-762-3162
Mailing Address - Fax:405-396-5211
Practice Address - Street 1:1011 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1828
Practice Address - Country:US
Practice Address - Phone:580-220-6658
Practice Address - Fax:580-220-6673
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK04752207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200250290AMedicaid
OKOK404229Medicare PIN