Provider Demographics
NPI:1427091826
Name:SECOY, RONALD WAYNE (PA-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:SECOY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2738
Mailing Address - Country:US
Mailing Address - Phone:405-779-2721
Mailing Address - Fax:405-779-2310
Practice Address - Street 1:113 S RUSH STREET
Practice Address - Street 2:
Practice Address - City:RUSH SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:73082-0277
Practice Address - Country:US
Practice Address - Phone:580-476-2527
Practice Address - Fax:580-476-3707
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100053660BMedicaid
OK100053660BMedicaid
OK249317501Medicare PIN
OKR83919Medicare UPIN