| NPI | 1306447172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHASTA R MANUEL Vice President Finance 405-272-7282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 207V00000X Obstetrics & Gynecology | |
| 208100000X Physical Medicine & Rehabilitation | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2024-03-20 |