| NPI | 1083041966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON P LAIRD Owner 580-363-0052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 1532) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2022-04-10 |