Healthcare Provider Details

I. General information

NPI: 1487424859
Provider Name (Legal Business Name): PREMIER PARADOX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 NW 56TH ST
OKLAHOMA CITY OK
73112-4518
US

IV. Provider business mailing address

3524 NW 56TH ST
OKLAHOMA CITY OK
73112-4518
US

V. Phone/Fax

Practice location:
  • Phone: 405-657-3120
  • Fax: 405-657-3122
Mailing address:
  • Phone: 405-657-3120
  • Fax: 405-657-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK WOODSON
Title or Position: OWNER
Credential: MD
Phone: 405-657-3120