Healthcare Provider Details

I. General information

NPI: 1720336431
Provider Name (Legal Business Name): NORMAN SURGICAL ARTS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 24TH AVE SW
NORMAN OK
73069-3913
US

IV. Provider business mailing address

640 24TH AVE SW
NORMAN OK
73069-3913
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6777
  • Fax: 405-364-6789
Mailing address:
  • Phone: 405-364-6777
  • Fax: 405-364-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: M EDMUND BRALY
Title or Position: OWNER
Credential: DDS
Phone: 405-364-6777