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General NPI Number Information
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NPI Number | 1043354228
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Entity Type | Organization
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Legal Business Name | PREMIERE PEDIATRICS PLLC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 3261 24TH AVE NW STE 101
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City | NORMAN
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State | OK
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Zip | 73069-6666
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Country | US
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Telephone | 405-364-6432
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Fax | 405-364-0090
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Provider Business Mailing Address
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Address Line | 3261 24TH AVE NW STE 101
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City | NORMAN
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State | OK
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Zip | 73069-6666
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Country | US
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Telephone | 405-364-6432
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Fax | 405-364-0090
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MRS. BREANNA DAWN WROBLEWSKI
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Credential |
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Telephone | 405-928-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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