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General NPI Number Information
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NPI Number | 1962378281
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Entity Type | Organization
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Legal Business Name | I V LEAGUE LLC
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 5721 NW 132ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-4437
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Country | US
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Telephone | 405-473-0210
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Fax |
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Provider Business Mailing Address
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Address Line | 5721 NW 132ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-4437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWBER
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Name | RANDY PATTERSON
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Credential | MD
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Telephone | 405-473-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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