| NPI | 1104291236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARON G. STREET President 918-505-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2025-08-11 |