Healthcare Provider Details

I. General information

NPI: 1992841811
Provider Name (Legal Business Name): GENERAL SURGERY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD 2ND FLOOR
EDMOND OK
73013-3023
US

IV. Provider business mailing address

PO BOX 20007
OKLAHOMA CITY OK
73156-0007
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2468
  • Fax: 405-286-4952
Mailing address:
  • Phone: 405-936-8200
  • Fax: 405-286-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY F WALTON
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 405-936-8200