Healthcare Provider Details

I. General information

NPI: 1619936838
Provider Name (Legal Business Name): GANGA M PUJARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 E RENO AVE SUITE 104
MIDWEST CITY OK
73110-2128
US

IV. Provider business mailing address

6908 E RENO AVE SUITE 104
MIDWEST CITY OK
73110-2128
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-0055
  • Fax: 405-736-6311
Mailing address:
  • Phone: 405-736-0055
  • Fax: 405-736-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: