Facts
- Status
- A
- Credential
- PAC
- Type
- Individual
- Enumeration date
- 2008-06-07
- Last updated
- 2011-07-18
Specialties
Licenses
- License OK
- 746
Location
- Practice location
- 1401 N 4TH AVE, SUITE 201
- City
- PURCELL OK
- Postal code
- 730801806
- Phone
- 405-527-5400
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.