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General NPI Number Information
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NPI Number | 1063573459
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Entity Type | Organization
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Legal Business Name | AL-BOTROS PLLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 1111 N LEE AVE STE 105
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2620
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Country | US
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Telephone | 405-600-6730
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Fax | 405-600-6750
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Provider Business Mailing Address
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Address Line | 1111 N LEE AVE STE 105
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2620
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Country | US
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Telephone | 405-600-6730
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Fax | 405-600-6750
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ADONIS SIMON AL-BOTROS
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Credential | M.D.
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Telephone | 405-600-6730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21751
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License Number State | OK
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