MEDICARE: BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS

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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1184185803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST # 274
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-271-1515
Fax Number	:	405-271-1001

Provider Business Practice Location Address
First Line	:	1000 N LINCOLN BLVD STE 1308
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-3252
Country	:	US
Telephone Number	:	405-421-2959
Fax Number	:	405-271-2836

Authorized Official
Title or Position	:	EXECUTIVE DEAN
Name	:	JOHN P ZUBIALDE
Credential	:	MD
Telephone Number	:	405-271-1515

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	01/06/2020

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