Basic Information
| Provider Information | |||||||||
| NPI: | 1033360979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CIMARRON ORTHOPEDICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 819 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740760819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057077500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 N PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740755513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057077500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | ATTEBERRY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | MARVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4057077500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | 12759 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.