Provider Demographics
NPI:1447253737
Name:RIGNEY, MARK EDWARD (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:RIGNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FAIRVIEW AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1924
Mailing Address - Country:US
Mailing Address - Phone:580-765-6647
Mailing Address - Fax:580-765-6699
Practice Address - Street 1:425 FAIRVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1924
Practice Address - Country:US
Practice Address - Phone:580-765-6647
Practice Address - Fax:580-765-6699
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200011960AMedicaid
7029546OtherAETNA
OK200011960AMedicaid
I09819Medicare UPIN