| NPI | 1326234584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM SHI CONNALLY Member 405-329-4102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 23363) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 17833) |
| 208600000X Surgery (Licence: OK 24274) | |
| 208600000X Surgery (Licence: OK 26881) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: OK 9306) | |
| 363L00000X Nurse Practitioner (Licence: OK R0054197) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2013-01-15 |