Healthcare Provider Details

I. General information

NPI: 1386035285
Provider Name (Legal Business Name): CERTIFIED ALLERGY, ASTHMA, AND IMMUNOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N VAN BUREN ST
ENID OK
73703-1729
US

IV. Provider business mailing address

2821 N VAN BUREN ST
ENID OK
73703-1729
US

V. Phone/Fax

Practice location:
  • Phone: 580-213-9799
  • Fax: 580-234-2474
Mailing address:
  • Phone: 580-213-9799
  • Fax: 580-234-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number29671
License Number StateOK

VIII. Authorized Official

Name: DR. TIMOTHY D TROJAN
Title or Position: OWNER
Credential: M.D.
Phone: 580-213-9799