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Physician Assistants & Advanced Practice Nursing Providers Physician Assistant

Provider NPI: 1881621241

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
2225 SW 59TH ST  OKLAHOMA CITY, OK 73119-7026 US
Tel: 405-688-7700  Fax: --

Business Mailing Address:
206 STEVE CT  YUKON, OK 73099-6549 US
Tel: 405-831-5698  Fax: --

NPI Information:
NPI: 1881621241
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363A00000X





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