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NPI Code Detail

MEDICARE: PRIMACARE LP

MEDICARE: PRIMACARE LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1104155985
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMACARE LP
Provider Business Mailing Address
First Line : 9031 SW 29TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73179-2818
Country : US
Telephone Number : 405-512-6950
Fax Number : 405-512-6960
Provider Business Practice Location Address
First Line : 9031 SW 29TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73179-2818
Country : US
Telephone Number : 405-512-6950
Fax Number : 405-512-6960
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DARRIN WEBSTER
Credential : D.O.
Telephone Number : 405-512-6950
Provider Enumeration Date : 12/08/2009
Last Update Date : 12/08/2009

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Directions to “PRIMACARE LP ” Practice Location

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