Healthcare Provider Details

I. General information

NPI: 1114408762
Provider Name (Legal Business Name): OKLAHOMA PROTON CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W MEMORIAL RD
OKLAHOMA CITY OK
73142-2015
US

IV. Provider business mailing address

PO BOX 218
LOWELL AR
72745-0218
US

V. Phone/Fax

Practice location:
  • Phone: 918-798-9160
  • Fax:
Mailing address:
  • Phone: 866-317-3801
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID JAMES RAUBACH
Title or Position: OFFICER
Credential:
Phone: 918-798-9160