| NPI | 1396487013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARNELL E. BLACKMON Owner 918-830-0059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-09-24 |