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General NPI Number Information
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NPI Number | 1831342906
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Entity Type | Organization
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Legal Business Name | ELLIOTT MEDICAL SERVICES, INC
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 11/02/2008
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Provider Practice Location Address
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Address Line | 122 E EUFAULA ST
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City | NORMAN
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State | OK
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Zip | 73069-6017
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Country | US
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Telephone | 405-640-9085
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Fax | 405-360-5607
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Provider Business Mailing Address
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Address Line | 3334 W MAIN ST # 523
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City | NORMAN
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State | OK
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Zip | 73072-4805
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Country | US
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Telephone | 405-640-9085
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Fax | 405-360-5607
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOB ELLIOTT
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Credential | D.O.
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Telephone | 405-640-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2366
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License Number State | OK
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