Active NPI
Mark Jeremy Rosengren, D.O.
- Family Medicine Physician
- Holdenville, OK
National Provider Identifier
1700040565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 8261
- Practice address
- 100 McDougal Dr
Holdenville, OK 74848-2822 - Phone
- (405) 379-4201
- Fax
- (405) 379-4264
- NPI assigned
- Jul 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8261 | OK | Primary |
Addresses
Primary practice location
100 McDougal Dr
Holdenville, OK 74848-2822
Mailing address
100 McDougal Dr
Holdenville, OK 74848-2822
Phone (405) 379-4259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8261 | OK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1700040565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MCDOUGAL DR",
"city": "HOLDENVILLE",
"state": "OK",
"postal_code": "748482822",
"telephone_number": "405-379-4259",
"fax_number": "405-379-4252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MCDOUGAL DR",
"city": "HOLDENVILLE",
"state": "OK",
"postal_code": "748482822",
"telephone_number": "405-379-4201",
"fax_number": "405-379-4264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENGREN",
"first_name": "MARK",
"middle_name": "JEREMY",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "8261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holdenville, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.