| NPI | 1942919998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C BALES Authorized Official 405-953-7221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2025-10-10 |