Healthcare Provider Details

I. General information

NPI: 1568985182
Provider Name (Legal Business Name): FRALEY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W I 35 FRONTAGE RD STE 100
EDMOND OK
73034-7399
US

IV. Provider business mailing address

925 W I 35 FRONTAGE RD STE 100
EDMOND OK
73034-7399
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-5460
  • Fax: 405-471-6513
Mailing address:
  • Phone: 405-601-6181
  • Fax: 405-601-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA FRALEY
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 405-471-5460