Healthcare Provider Details

I. General information

NPI: 1629726716
Provider Name (Legal Business Name): UROGYNECOLOGY OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 HEFNER POINTE DR STE B
OKLAHOMA CITY OK
73120-5049
US

IV. Provider business mailing address

11525 WATERS WELLING WAY
EDMOND OK
73013-8010
US

V. Phone/Fax

Practice location:
  • Phone: 405-400-8188
  • Fax: 405-938-1008
Mailing address:
  • Phone: 405-698-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIELLE ALLEN
Title or Position: PHYSICIAN
Credential: DO
Phone: 405-400-8188