Healthcare Provider Details

I. General information

NPI: 1396018735
Provider Name (Legal Business Name): PHYSICIANS CENTER FOR WEIGHT MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7249 S WESTERN AVE STE 201
OKLAHOMA CITY OK
73139-2011
US

IV. Provider business mailing address

7249 S WESTERN AVE STE 201
OKLAHOMA CITY OK
73139-2011
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-0111
  • Fax: 405-632-8225
Mailing address:
  • Phone: 405-632-0111
  • Fax: 405-632-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number12308
License Number StateOK

VIII. Authorized Official

Name: DR. LEE FRYE
Title or Position: OWNER
Credential: MD
Phone: 405-632-0111