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General NPI Number Information
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NPI Number | 1083978787
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Entity Type | Organization
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Legal Business Name | SRD ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 3800 W OKMULGEE ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-4933
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Country | US
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Telephone | 918-682-9899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 388
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City | NEWTON
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State | KS
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Zip | 67114-0388
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Country | US
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Telephone | 316-281-3700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUDHIR DAFTARY
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Credential | MD
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Telephone | 918-682-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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