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General NPI Number Information
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NPI Number | 1497038327
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Entity Type | Organization
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Legal Business Name | BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA-OU PHYSICIANS
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 14101 N EASTERN AVENUE
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-359-0919
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Fax | 405-340-1555
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Provider Business Mailing Address
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Address Line | 1122 NE 13TH ST ORI 274
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City | OKLAHOMA CITY
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State | OK
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Zip | 73117-1039
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Country | US
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Telephone | 405-359-0919
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Fax | 405-340-1555
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | BRIAN L MADDY
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Credential |
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Telephone | 405-271-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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