Healthcare Provider Details

I. General information

NPI: 1568011344
Provider Name (Legal Business Name): OKLAHOMA FOOT AND ANKLE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N KICKAPOO AVE STE 104
SHAWNEE OK
74804-0007
US

IV. Provider business mailing address

3001 S TELEPHONE RD # B
MOORE OK
73160-2942
US

V. Phone/Fax

Practice location:
  • Phone: 405-794-6691
  • Fax: 405-794-9856
Mailing address:
  • Phone: 405-794-6691
  • Fax: 405-794-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT E MORRIS
Title or Position: AUTHORIZED/DOCTOR
Credential:
Phone: 405-794-6691