Provider Demographics
NPI:1174562763
Name:BOURNE, CATRINA F (MD)
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:F
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 STONEMILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5770
Mailing Address - Country:US
Mailing Address - Phone:405-919-3332
Mailing Address - Fax:
Practice Address - Street 1:1820 COMMONS CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9518
Practice Address - Country:US
Practice Address - Phone:405-265-2778
Practice Address - Fax:405-494-7274
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200012660AMedicaid
OK200012660AMedicaid
OK243435114Medicare PIN