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General NPI Number Information
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NPI Number | 1164718961
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Entity Type | Organization
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Legal Business Name | UCR MEDICAL, INC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 309 E RAY FINE BLVD
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City | ROLAND
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State | OK
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Zip | 74954-5160
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Country | US
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Telephone | 918-503-6257
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Fax | 918-503-6259
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Provider Business Mailing Address
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Address Line | 309 E RAY FINE BLVD
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City | ROLAND
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State | OK
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Zip | 74954-5160
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Country | US
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Telephone | 918-503-6257
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Fax | 918-503-6259
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK J FUOCO
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Credential |
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Telephone | 985-869-0271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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