| NPI | 1902959141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD D STINSON Accounting Manager 918-635-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-22 |