Organization Name: | STATE OF OKLAHOMA |
NPI Number: | 1972907178 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY GROSS (EXECUTIVE DIRECTOR) |
Mailing Address: | 900 E Main St Norman |
State: | OK US |
Postal Code: | 730715305 |
Phone Number: | 4055736600 |
Fax Number: | 4055733960 |
NPI Enumeration Date: | 10/17/2014 |
NPI Last Update Date: | 10/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |