| NPI | 1871303503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYESHA MOSQUITO Physician Relations Director 918-519-4090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208VP0000X |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-11-18 |