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General NPI Number Information
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NPI Number | 1023063260
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Entity Type | Organization
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Legal Business Name | ENID RADIOLOGY PLLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 305 S 5TH ST
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City | ENID
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State | OK
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Zip | 73701-5832
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Country | US
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Telephone | 580-234-2878
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1847
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City | ENID
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State | OK
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Zip | 73702-1847
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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 | ADMINISTRATIVE MANAGER
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Name | PHILIP MALONE
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Credential |
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Telephone | 405-321-8125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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