Healthcare Provider Details

I. General information

NPI: 1295221422
Provider Name (Legal Business Name): FLEXOGENIX OKLAHOMA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 N KELLEY AVE
OKLAHOMA CITY OK
73131-2427
US

IV. Provider business mailing address

1000 S HOPE ST STE 103
LOS ANGELES CA
90015-4058
US

V. Phone/Fax

Practice location:
  • Phone: 213-455-7804
  • Fax: 213-261-3816
Mailing address:
  • Phone: 213-455-7803
  • Fax: 213-261-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN PATRICK WHALEN
Title or Position: CMO/CBDO
Credential: MD
Phone: 213-455-7804