Healthcare Provider Details

I. General information

NPI: 1922356310
Provider Name (Legal Business Name): DYNAMIC MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S BOULEVARD BLDG B SUITE 18B
EDMOND OK
73013-5486
US

IV. Provider business mailing address

3500 S BOULEVARD BLDG B SUITE 18B
EDMOND OK
73013-5486
US

V. Phone/Fax

Practice location:
  • Phone: 405-570-9962
  • Fax:
Mailing address:
  • Phone: 405-570-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEX THEODORIDIS
Title or Position: PRESIDENT
Credential:
Phone: 405-570-9962