Healthcare Provider Details

I. General information

NPI: 1487057345
Provider Name (Legal Business Name): AVANT DIABETTES MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 SW 59TH ST
OKLAHOMA CITY OK
73119-7026
US

IV. Provider business mailing address

2225 SW 59TH ST
OKLAHOMA CITY OK
73119-7026
US

V. Phone/Fax

Practice location:
  • Phone: 800-420-1481
  • Fax: 800-361-4480
Mailing address:
  • Phone: 800-420-1481
  • Fax: 800-361-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAMS J DRAGOO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 800-420-1481