MEDICARE: GREGORY C KHOURY MD AMPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	13298	OK
2	2084P0800X	Psychiatry Physician	13298	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B89239	OTHER	LA	UPIN - ORIGINALLY ISSUED

General Provider Information

NPI Number	:	1023218468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY C KHOURY MD AMPC

Provider Business Mailing Address
First Line	:	3240 W BRITTON RD
Second Line	:	SUITE 102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2040
Country	:	US
Telephone Number	:	405-936-9410
Fax Number	:	405-936-9474

Provider Business Practice Location Address
First Line	:	3240 W BRITTON RD
Second Line	:	SUITE 102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2040
Country	:	US
Telephone Number	:	405-936-9410
Fax Number	:	405-936-9474

Authorized Official
Title or Position	:	PRESIDENT / MEDICAL DIRECTOR
Name	:	DR. GREGORY C KHOURY
Credential	:	MD
Telephone Number	:	405-936-9410

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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