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General NPI Number Information
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NPI Number | 1528375995
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Entity Type | Organization
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Legal Business Name | EM MADD, LLC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 8803 S 101ST EAST AVE SUITE 383
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-994-4130
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Fax | 918-994-4132
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Provider Business Mailing Address
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Address Line | 8803 S 101ST EAST AVE SUITE 383
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-994-4130
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Fax | 918-994-4132
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN D WORLEY
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Credential | MD
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Telephone | 918-994-4130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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