| NPI | 1740261494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL B SCOTT Owner 580-233-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 1905) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 1905) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2020-08-22 |