Basic Information
| Provider Information | |||||||||
| NPI: | 1831441187 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKC PULMONARY SPECIALIST PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 W GRAY ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730697117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058094222 | ||||||||
| FaxNumber: | 4053645379 | ||||||||
| Practice Location | |||||||||
| Address1: | 1407 N ROBINSON AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731034823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052328000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 10/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | GREGORY | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4054649216 | ||||||||
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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 | 207RP1001X | 24490 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.