Healthcare Provider Details

I. General information

NPI: 1083557839
Provider Name (Legal Business Name): OKC GYN/OB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 N PORTLAND AVE FL 2
OKLAHOMA CITY OK
73120-5045
US

IV. Provider business mailing address

11200 N PORTLAND AVE FL 2
OKLAHOMA CITY OK
73120-5045
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-1151
  • Fax: 405-936-1001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAM JEAN HODGES
Title or Position: BILLING OFFICE
Credential:
Phone: 405-936-1151