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General NPI Number Information
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NPI Number | 1033145370
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Entity Type | Organization
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Legal Business Name | WESTPORT FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 2400 PALMER CIR
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City | NORMAN
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State | OK
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Zip | 73069-6301
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Country | US
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Telephone | 405-321-6405
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Fax | 405-321-6457
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Provider Business Mailing Address
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Address Line | PO BOX 268822
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8822
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Country | US
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Telephone | 405-321-6405
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Fax | 405-321-6457
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Authorized Official
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Title or Position | PARTNER
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Name | JIM D DAVIS
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Credential | DO
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Telephone | 405-321-6405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3845
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License Number State | OK
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