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General NPI Number Information
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NPI Number | 1457763757
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Entity Type | Organization
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Legal Business Name | SURGICAL PARTNERS OF OKLAHOMA
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 1808 COMMONS CIRCLE
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City | YUKON
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State | OK
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Zip | 73099-9518
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Country | US
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Telephone | 405-265-2210
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Fax | 405-265-2256
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Provider Business Mailing Address
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Address Line | 1808 COMMONS CIRCLE
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City | YUKON
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State | OK
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Zip | 73099-9518
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Country | US
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Telephone | 405-265-2210
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Fax | 405-265-2256
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADY SCOTT HAGOOD
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Credential | MD
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Telephone | 405-265-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 21970
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License Number State | OK
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