| NPI | 1487677456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHASTA RENE MANUEL VP Finance 405-272-7282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| 207LP2900X Anesthesiology Pain Medicine | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-04-29 |