| NPI | 1144235995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES LACKEY Owner 405-366-8619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OK 12222) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2011-08-31 |