Healthcare Provider Details

I. General information

NPI: 1407984693
Provider Name (Legal Business Name): OTOLOGIC MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW 56TH ST
OKLAHOMA CITY OK
73112-4463
US

IV. Provider business mailing address

3400 NW 56TH ST
OKLAHOMA CITY OK
73112-4463
US

V. Phone/Fax

Practice location:
  • Phone: 405-946-5563
  • Fax: 405-947-6226
Mailing address:
  • Phone: 405-946-5563
  • Fax: 405-947-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CLARENCE VOTH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 405-946-5563