Healthcare Provider Details

I. General information

NPI: 1023218468
Provider Name (Legal Business Name): GREGORY C KHOURY MD AMPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 W BRITTON RD SUITE 102
OKLAHOMA CITY OK
73120-2040
US

IV. Provider business mailing address

3240 W BRITTON RD SUITE 102
OKLAHOMA CITY OK
73120-2040
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-9410
  • Fax: 405-936-9474
Mailing address:
  • Phone: 405-936-9410
  • Fax: 405-936-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13298
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13298
License Number StateOK

VIII. Authorized Official

Name: DR. GREGORY C KHOURY
Title or Position: PRESIDENT / MEDICAL DIRECTOR
Credential: MD
Phone: 405-936-9410