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General NPI Number Information
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NPI Number | 1194751834
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Entity Type | Organization
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Legal Business Name | BROKEN ARROW BONE AND JOINT SPECIALISTS, PC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2950 S ELM PL SUITE 460
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7877
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Country | US
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Telephone | 918-451-1100
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Fax | 918-451-0082
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Provider Business Mailing Address
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Address Line | 2950 S ELM PL SUITE 460
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7877
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Country | US
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Telephone | 918-451-1100
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Fax | 918-451-0082
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL DAVID PETERSON
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Credential | M.D.
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Telephone | 918-451-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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