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General NPI Number Information
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NPI Number | 1184152001
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Entity Type | Organization
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Legal Business Name | OKLAHOMA CHRONIC PAIN SPECIALISTS, PLLC
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 10124 S SHERIDAN RD STE B
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City | TULSA
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State | OK
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Zip | 74133-6742
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Country | US
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Telephone | 774-473-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 10124 S SHERIDAN RD, STE B
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City | TULSA
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State | OK
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Zip | 74133
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Country | US
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Telephone | 774-473-9119
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Fax |
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Authorized Official
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Title or Position | OWNER AND PRESIDENT
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Name | DR. EMAD S ATTALLAH-WASIF
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Credential | MD
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Telephone | 774-473-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 31431
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 31431
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 31431
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License Number State | OK
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