Healthcare Provider Details

I. General information

NPI: 1437397262
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF OKLAHOMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-0175
  • Fax: 954-858-0434
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-858-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL D STANLEY
Title or Position: DIRECTOR
Credential: M.D.
Phone: 954-384-0175