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General NPI Number Information
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NPI Number | 1013207505
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Entity Type | Organization
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Legal Business Name | OKLAHOMA PAIN & REHAB LLC
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 2149 SW 59TH ST SUITE 201
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7033
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Country | US
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Telephone | 405-681-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 2149 SW 59TH ST SUITE 201
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM RYAN
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Credential |
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Telephone | 405-926-7926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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