| NPI | 1205567047 |
|---|---|
| Doing Business As | OSU-AJ SOUTHSIDE DERMATOLOGY BROKEN ARROW |
| Entity Type | Organization |
| Authorized Contact | ERIC JOHN POLAK Vice President Of Admin/Finance 918-561-8422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-06-22 |