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General NPI Number Information
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NPI Number | 1548505258
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Entity Type | Organization
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Legal Business Name | EDMOND PEDIATRICS
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 2109 N KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73003-3908
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Country | US
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Telephone | 405-513-8880
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Fax | 405-285-5912
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Provider Business Mailing Address
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Address Line | 2109 N KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73003-3908
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Country | US
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Telephone | 405-513-8880
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Fax | 405-285-5912
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Authorized Official
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Title or Position | MD
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Name | TIMOTHY FREDRICK KROUS
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Credential |
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Telephone | 405-381-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 21244
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License Number State | OK
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