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General NPI Number Information
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NPI Number | 1265617443
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Entity Type | Organization
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Legal Business Name | NUVEEN COSMETIC & RECONSTRUCTIVE SURGERY, P.C.
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 2100 NW 63RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-5111
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Country | US
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Telephone | 405-842-6677
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Fax | 405-842-6678
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Provider Business Mailing Address
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Address Line | 2100 NW 63RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-5111
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Country | US
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Telephone | 405-842-6677
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Fax | 405-842-6678
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIK JON NUVEEN
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Credential | M.D., D.M.D.
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Telephone | 405-842-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 23411
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License Number State | OK
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