Healthcare Provider Details

I. General information

NPI: 1104018571
Provider Name (Legal Business Name): PANHANDLE RADIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NE 12TH ST
GUYMON OK
73942-3624
US

IV. Provider business mailing address

PO BOX 1030
GUYMON OK
73942-1030
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-6515
  • Fax: 580-225-5423
Mailing address:
  • Phone: 580-338-6515
  • Fax: 580-225-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23914
License Number StateOK

VIII. Authorized Official

Name: ROBERT A WILLIAMS
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 580-338-6515