Basic Information
| Provider Information | |||||||||
| NPI: | 1700087863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONVENIENT MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 NW 23RD ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731072442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059486300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 NW 23RD ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731072442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059486300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | DREW | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4059486300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 19879 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.