Healthcare Provider Details

I. General information

NPI: 1134257231
Provider Name (Legal Business Name): COLON AND RECTAL SURGERY OF OKLAHOMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 NW 56TH ST SUITE 760
OKLAHOMA CITY OK
73112-4461
US

IV. Provider business mailing address

3433 NW 56TH ST SUITE 760
OKLAHOMA CITY OK
73112-4461
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-0640
  • Fax: 405-948-1753
Mailing address:
  • Phone: 405-948-0640
  • Fax: 405-948-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS M. DAVIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-948-0640