Healthcare Provider Details

I. General information

NPI: 1528343159
Provider Name (Legal Business Name): ALLERGY, ASTHMA & CLINICAL RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 206
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 206
OKLAHOMA CITY OK
73120-9350
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-0393
  • Fax: 405-752-4242
Mailing address:
  • Phone: 405-752-0393
  • Fax: 405-752-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number10144
License Number StateOK

VIII. Authorized Official

Name: MARTHA TARPAY
Title or Position: OWNER
Credential: M.D.
Phone: 405-752-0393