| NPI | 1184269706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DALE GRIZZLE Owner 405-821-7726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 208VP0000X Pain Medicine Pain Medicine | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-07 |