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General NPI Number Information
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NPI Number | 1962716597
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Entity Type | Organization
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Legal Business Name | ALTUS SURGICAL&UROLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 304 S PARK LN SUITE B
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City | ALTUS
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State | OK
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Zip | 73521-5753
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Country | US
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Telephone | 580-379-6550
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Fax | 580-379-6559
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Provider Business Mailing Address
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Address Line | PO BOX 975
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City | ALTUS
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State | OK
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Zip | 73522-0975
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Country | US
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Telephone | 580-379-6550
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Fax | 580-379-6559
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MOUNIR G ZAKHARY
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Credential | MD
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Telephone | 580-379-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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