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General NPI Number Information
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NPI Number | 1245120401
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Entity Type | Organization
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Legal Business Name | GRD LEASING LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1140 S DOUGLAS BLVD
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City | MIDWEST CITY
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State | OK
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Zip | 73130-5236
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Country | US
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Telephone | 405-733-8000
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Fax | 405-338-7455
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Provider Business Mailing Address
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Address Line | PO BOX 403
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City | ELK CITY
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State | OK
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Zip | 73648-0403
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Country | US
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Telephone | 405-265-6099
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Fax | 405-338-7455
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Authorized Official
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Title or Position | OWNER
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Name | GRANT DETTEN
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Credential | DO
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Telephone | 580-716-7658
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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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