Basic Information
Provider Information
NPI: 1154462802
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAPPY
FirstName: REJI
MiddleName: MATHEW
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 608 NW 9TH ST
Address2: SUITE 2200
City: OKLAHOMA CITY
State: OK
PostalCode: 731021068
CountryCode: US
TelephoneNumber: 4052313737
FaxNumber: 4052726144
Practice Location
Address1: 608 NW 9TH ST
Address2: SUITE 2200
City: OKLAHOMA CITY
State: OK
PostalCode: 731021068
CountryCode: US
TelephoneNumber: 4052313737
FaxNumber: 4052726144
Other Information
ProviderEnumerationDate: 02/08/2007
LastUpdateDate: 10/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X24454OKY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207R00000X24454OKN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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