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General NPI Number Information
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NPI Number | 1396881959
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Entity Type | Organization
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Legal Business Name | EMERGENCY PHYSICIANS OF MIDWEST CITY L.L.C.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2412 PANTHEON CIR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170
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Country | US
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Telephone | 405-691-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 PANTHEON CIR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-3236
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Country | US
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Telephone | 405-691-1159
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Fax |
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Authorized Official
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Title or Position | PHYSIIAN
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Name | DR. DAN DONNELL
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Credential | M.D.
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Telephone | 405-348-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 363A00000X
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License Number State | OK
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