Healthcare Provider Details

I. General information

NPI: 1235207515
Provider Name (Legal Business Name): SOUTHWEST PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 SW 89TH ST SUITE A
OKLAHOMA CITY OK
73139-9231
US

IV. Provider business mailing address

937 SW 89TH ST SUITE A
OKLAHOMA CITY OK
73139-9231
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-2379
  • Fax:
Mailing address:
  • Phone: 405-631-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY RATLIFF
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-631-2379