Healthcare Provider Details

I. General information

NPI: 1104919042
Provider Name (Legal Business Name): THE ENDOCRINE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND STE 310
OKLAHOMA CITY OK
73112-2082
US

IV. Provider business mailing address

PO BOX 25887
OKLAHOMA CITY OK
73125-0887
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-4160
  • Fax: 405-951-4162
Mailing address:
  • Phone: 405-951-4160
  • Fax: 405-951-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES L MALES
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 405-951-4160