| NPI | 1346824679 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP FAMILY MEDICINE DOUGLAS |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment Coordinator 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-05-12 |