| NPI | 1538592332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRA ROLAN Phy Prac Coordinator 918-421-6987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207X00000X Orthopaedic Surgery | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |