Healthcare Provider Details

I. General information

NPI: 1801973821
Provider Name (Legal Business Name): DEACONESS METROPOLITAN PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N MUSTANG MALL TER
MUSTANG OK
73064-5135
US

IV. Provider business mailing address

206 N MUSTANG MALL TER
MUSTANG OK
73064-5135
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-6000
  • Fax: 405-256-6001
Mailing address:
  • Phone: 405-256-6000
  • Fax: 405-256-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: V KAREN FLINN
Title or Position: VP
Credential:
Phone: 214-473-3773