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General NPI Number Information
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NPI Number | 1861405847
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Entity Type | Organization
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Legal Business Name | MUSKOGEE DIAGNOSTIC IMAGING
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3300 CHANDLER RD SUITE 104
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City | MUSKOGEE
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State | OK
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Zip | 74403-4909
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Country | US
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Telephone | 918-684-7226
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Fax | 918-684-7227
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Provider Business Mailing Address
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Address Line | 3300 CHANDLER RD SUITE 104
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City | MUSKOGEE
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State | OK
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Zip | 74403-4909
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Country | US
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Telephone | 918-684-7226
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Fax | 918-684-7227
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. TIMOTHY ROBISON
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Credential | M.D.
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Telephone | 918-684-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | 700971
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License Number State | OK
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