Healthcare Provider Details

I. General information

NPI: 1457977845
Provider Name (Legal Business Name): LANDON MCGEE AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BROADWAY EXT STE 200
OKLAHOMA CITY OK
73114-6323
US

IV. Provider business mailing address

9900 BROADWAY EXT STE 200
OKLAHOMA CITY OK
73114-6323
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-8833
  • Fax:
Mailing address:
  • Phone: 405-608-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5317
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: