| NPI | 1083585491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILI GRAGG Operations Manager 405-219-2651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 208VP0000X | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 209800000X Legal Medicine | |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-09-17 |