| NPI | 1396234761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS DOOLY Member 918-647-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| 261QP1100X Clinic/Center, Podiatric | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-08-09 |