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General NPI Number Information
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NPI Number | 1528408523
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Entity Type | Organization
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Legal Business Name | ALTUS PREMIER HEALTH CLINIC P.L.L.C.
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 304 S PARK LN STE B
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City | ALTUS
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State | OK
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Zip | 73521-5754
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Country | US
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Telephone | 580-379-6550
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Fax | 580-379-6559
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Provider Business Mailing Address
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Address Line | 304 S PARK LN SUITE B
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City | ALTUS
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State | OK
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Zip | 73521-5753
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Country | US
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Telephone | 580-379-6550
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Fax | 580-379-6559
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Authorized Official
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Title or Position | M.D.
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Name | DR. ABDALLAH S DAWOD
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Credential | M.D.
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Telephone | 580-379-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 24330
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License Number State | OK
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