Basic Information
| Provider Information | |||||||||
| NPI: | 1710319918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORMAN INTERVENTIONAL PAIN MANAGEMENT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3650 W ROCK CREEK RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730722202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057013418 | ||||||||
| FaxNumber: | 4057013451 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 W ROCK CREEK RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730722202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057013418 | ||||||||
| FaxNumber: | 4057013451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2013 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 4057013418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.