| NPI | 1104070259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LOUISE FAGAN Physician Assistant 405-605-5415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 1779) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |