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General NPI Number Information
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NPI Number | 1417204140
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Entity Type | Organization
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Legal Business Name | BROOKS PAIN CLINIC LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 820 NW 13TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6827
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Country | US
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Telephone | 405-943-0303
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Fax | 405-272-0515
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Provider Business Mailing Address
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Address Line | 820 NW 13TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6827
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Country | US
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Telephone | 405-943-0303
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Fax | 405-272-0515
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Authorized Official
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Title or Position | OWNER
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Name | RODNEY MILLER
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Credential |
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Telephone | 405-943-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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