Healthcare Provider Details

I. General information

NPI: 1548398274
Provider Name (Legal Business Name): NORMAN REGIONAL PROVIDERS PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/02/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ROBINSON ST STE 2400
NORMAN OK
73071-6684
US

IV. Provider business mailing address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-0380
  • Fax:
Mailing address:
  • Phone: 405-307-1000
  • Fax:

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD D WAGNER
Title or Position: CO-CEO
Credential:
Phone: 405-515-1000