Healthcare Provider Details

I. General information

NPI: 1053302380
Provider Name (Legal Business Name): SOUTHERN OKLAHOMA PET IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ROBINSON ST SUITE 102
NORMAN OK
73071-6625
US

IV. Provider business mailing address

PO BOX 1509
NORMAN OK
73070-1509
US

V. Phone/Fax

Practice location:
  • Phone: 405-928-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSIE FRANTZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 405-321-8125