Basic Information
| Provider Information | |||||||||
| NPI: | 1366489213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE DISEASE SPECIALISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7316 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730837316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057676630 | ||||||||
| FaxNumber: | 4057671176 | ||||||||
| Practice Location | |||||||||
| Address1: | 5015 N PENNSYLVANIA AVE | ||||||||
| Address2: | STE. 303 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731128891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057676630 | ||||||||
| FaxNumber: | 4057671176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4057676630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.