Healthcare Provider Details

I. General information

NPI: 1477833523
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N PHILLIPS AVE SUITE 9500
OKLAHOMA CITY OK
73104-4600
US

IV. Provider business mailing address

1200 N PHILLIPS AVE SUITE 9500
OKLAHOMA CITY OK
73104-4600
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5884
  • Fax: 405-271-7866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number81001
License Number StateOK

VIII. Authorized Official

Name: JOHN GRUNOW
Title or Position: PEDIATRIC GASTROENTEROLOGY CHAIR
Credential: MD
Phone: 405-271-5884