is a Physician Assistant in Oklahoma City, Oklahoma. practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for is 1770740680. The last update date is .
's current location address is 14100 Parkway Commons Dr Ste 100, Oklahoma City, Oklahoma. You can contact this provider via phone number 4057483300 and fax number 4057491671. The mailing address for is 14100 Parkway Commons Dr Ste 100, Oklahoma City, Oklahoma. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 14100 Parkway Commons Dr Ste 100, Oklahoma City, Oklahoma |
| Phone Number | 4057483300 |
| Fax Number | 4057491671 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1770740680 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 14100 Parkway Commons Dr Ste 100 |
|---|---|
| City | Oklahoma City |
| State | Oklahoma (OK) |
| Post Code | 731346036 |
| Phone Number | 4057483300 |
| Fax Number | 4057491671 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | 1717 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200202480A | OK | -- |
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