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General NPI Number Information
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NPI Number | 1932258613
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Entity Type | Organization
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Legal Business Name | SOUTHERN OKLAHOMA PODIATRY SERVICES PLLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 2002 12TH AVE NW SUITE F
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City | ARDMORE
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State | OK
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Zip | 73401-1227
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Country | US
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Telephone | 580-223-0718
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Fax | 580-223-0719
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Provider Business Mailing Address
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Address Line | 2002 12TH AVE NW SUITE F
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City | ARDMORE
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State | OK
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Zip | 73401-1227
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Country | US
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Telephone | 580-223-0718
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Fax | 580-223-0719
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Authorized Official
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Title or Position | OWNER
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Name | LLOYD B LANDIS
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Credential | D.P.M.
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Telephone | 580-223-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State | OK
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