Provider Demographics
NPI:1306875729
Name:STUDEBAKER, MARION K (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:K
Last Name:STUDEBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6737
Mailing Address - Country:US
Mailing Address - Phone:405-936-5910
Mailing Address - Fax:405-577-2605
Practice Address - Street 1:520 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6737
Practice Address - Country:US
Practice Address - Phone:405-936-5910
Practice Address - Fax:405-577-2605
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13434OtherLICENSE
OK100088380AMedicaid
OK080020799OtherRAILROAD
OK20466OtherOBNDD
E11698Medicare UPIN
OK100088380AMedicaid