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General NPI Number Information
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NPI Number | 1730732116
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Entity Type | Organization
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Legal Business Name | NUGENEX HEALTH LLC
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 929 NW 164TH ST # 342
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City | EDMOND
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State | OK
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Zip | 73013-1002
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Country | US
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Telephone | 903-401-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 929 NW 164TH ST # 342
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City | EDMOND
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State | OK
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Zip | 73013-1002
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Country | US
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Telephone | 903-401-1861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY M SEYMOUR
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Credential | APRN-CNP
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Telephone | 903-401-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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