| NPI | 1760077499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-03-04 |