Healthcare Provider Details

I. General information

NPI: 1245432095
Provider Name (Legal Business Name): SPECTRUM MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
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: 405-688-7700
  • Fax: 405-688-7702
Mailing address:
  • Phone: 405-688-7700
  • Fax: 405-688-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number23361
License Number StateOK

VIII. Authorized Official

Name: DR. HAMID MAHMOOD
Title or Position: FAMILY PRACTICE PHYSICIAN
Credential: M.D.
Phone: 405-688-7700