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General NPI Number Information
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NPI Number | 1568777043
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Entity Type | Organization
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Legal Business Name | GUY E. GROOMS, M.D., P.C.
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 209 S 36TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-5043
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Country | US
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Telephone | 918-682-7717
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Fax | 918-682-9434
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Provider Business Mailing Address
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Address Line | 209 S 36TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-5043
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Country | US
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Telephone | 918-682-7717
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Fax | 918-682-9434
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLI COLLEEN STEVENSON
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Credential |
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Telephone | 918-682-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 20183
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License Number State | OK
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