Healthcare Provider Details

I. General information

NPI: 1194704494
Provider Name (Legal Business Name): MUSKOGEE PET AND NUCLEAR IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 CHANDLER RD SUITE #106
MUSKOGEE OK
74403-4909
US

IV. Provider business mailing address

3300 CHANDLER RD SUITE #106
MUSKOGEE OK
74403-4909
US

V. Phone/Fax

Practice location:
  • Phone: 918-686-7382
  • Fax: 918-686-7995
Mailing address:
  • Phone: 918-686-7382
  • Fax: 918-686-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY D ROBISON
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 918-686-7382