| NPI | 1497944573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD LEWIS DICKMAN Physician 405-945-4828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OK 1726) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-17 |