Basic Information
| Provider Information | |||||||||
| NPI: | 1770528911 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAYTON ROYSE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25887 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731250887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802372327 | ||||||||
| FaxNumber: | 5802372339 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 W I 240 SERVICE RD | ||||||||
| Address2: | SUITE F100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731392171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056056141 | ||||||||
| FaxNumber: | 4056056244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROYSE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | DAYTON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4052886403 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 7263 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 100733230A | 05 | OK | MEDICAID | 443269618002 | 01 | OK | BC/BS OF OK | OTHER |