| NPI | 1104830090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY ROBERT LEE Owner 918-381-6326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 16665) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 16665) |
| 202C00000X Independent Medical Examiner (Licence: OK 16665) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-05-04 |