Healthcare Provider Details

I. General information

NPI: 1114267549
Provider Name (Legal Business Name): OKLAHOMA MEDICAL RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 13TH ST
OKLAHOMA CITY OK
73104-5005
US

IV. Provider business mailing address

825 NE 13TH ST
OKLAHOMA CITY OK
73104-5005
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7210
  • Fax:
Mailing address:
  • Phone: 405-271-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberE1235
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number156548
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number25222
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL 'CHIP' MORGAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 405-271-7410