Healthcare Provider Details

I. General information

NPI: 1831272889
Provider Name (Legal Business Name): COMPREHENSIVE CANCER CENTER OF OKLAHOMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 56TH ST SUITE D-100
OKLAHOMA CITY OK
73112-4550
US

IV. Provider business mailing address

3525 NW 56TH ST SUITE D-100
OKLAHOMA CITY OK
73112-4550
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-9200
  • Fax: 405-942-9219
Mailing address:
  • Phone: 405-942-9200
  • Fax: 405-942-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY PARKER
Title or Position: PRESIDENT
Credential: MD
Phone: 405-942-9200