MEDICARE: CONVENIENT MEDICAL

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	207Q00000X	Family Medicine Physician	19879	OK

General Provider Information

NPI Number	:	1700087863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVENIENT MEDICAL

Provider Business Mailing Address
First Line	:	2401 NW 23RD ST
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2442
Country	:	US
Telephone Number	:	405-948-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 NW 23RD ST
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2442
Country	:	US
Telephone Number	:	405-948-6300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DREW K COOPER
Credential	:	MD
Telephone Number	:	405-948-6300

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	11/14/2007

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