Healthcare Provider Details

I. General information

NPI: 1548470446
Provider Name (Legal Business Name): WOMANCARE OF OKLAHOMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 N PORTLAND AVE SUITE 320
OKLAHOMA CITY OK
73112-1678
US

IV. Provider business mailing address

5701 N PORTLAND AVE SUITE 320
OKLAHOMA CITY OK
73112-1678
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-6415
  • Fax: 405-292-5505
Mailing address:
  • Phone: 405-949-6415
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15413
License Number StateOK

VIII. Authorized Official

Name: JAMES E SHORT
Title or Position: PRESIDENT
Credential: MD
Phone: 405-949-6415