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General NPI Number Information
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NPI Number | 1609893403
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Entity Type | Organization
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Legal Business Name | ACCESS ENDOCRINE, THYROID AND DIABETES CENTER
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 6001 NW 120TH CT SUITE 6
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-1700
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Country | US
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Telephone | 405-728-7329
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Fax | 405-720-2611
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Provider Business Mailing Address
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Address Line | PO BOX 268988
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8988
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Country | US
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Telephone | 405-843-2066
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Fax | 405-843-2077
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Authorized Official
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Title or Position | OWNER
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Name | MODHI GUDE
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Credential | MD
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Telephone | 405-728-7329
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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 | 13262
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License Number State | OK
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