| NPI | 1174892590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON PAGE LAIRD Owner 918-762-3601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK OK1532) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK PA763) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2012-04-05 |