Basic Information
| Provider Information | |||||||||
| NPI: | 1265796023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADRIAN | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | COLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAYLOR | ||||||||
| OtherFirstName: | CELESTE | ||||||||
| OtherMiddleName: | COLEEN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 435 N MONTE VISTA ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803100102 | ||||||||
| FaxNumber: | 5803100104 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 N MONTE VISTA ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803100102 | ||||||||
| FaxNumber: | 5803100104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 32906 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.