Healthcare Provider Details

I. General information

NPI: 1508432048
Provider Name (Legal Business Name): SPINE SURGERY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 PARKWAY COMMONS DR STE 200
OKLAHOMA CITY OK
73134-6104
US

IV. Provider business mailing address

14100 PARKWAY COMMONS DR STE 200
OKLAHOMA CITY OK
73134-6104
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-4345
  • Fax: 405-242-4333
Mailing address:
  • Phone: 405-242-4345
  • Fax: 405-242-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES ODOR
Title or Position: OWNER
Credential: MD
Phone: 405-242-4345