Healthcare Provider Details

I. General information

NPI: 1407180748
Provider Name (Legal Business Name): SKIN SURGERY CENTER OF OKLAHOMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 301
OKLAHOMA CITY OK
73114-1432
US

IV. Provider business mailing address

13100 N WESTERN AVE STE 301
OKLAHOMA CITY OK
73114-1432
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-6647
  • Fax: 405-948-6647
Mailing address:
  • Phone: 405-947-6647
  • Fax: 405-948-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4552
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON RHINEHART
Title or Position: PRESIDENT
Credential: D.O.
Phone: 405-947-6647