| NPI | 1437398112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN PAUL MEDEIROS Owner 918-635-3578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 2800) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 2800) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2014-04-08 |