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105 S Bryant Ave Ste 404 Edmond OK 73034-6331 | |
| (405) 271-2663 | |
| (405) 271-3074 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 105 S Bryant Ave Ste 404, Edmond, Oklahoma |
| Authorized Official Name and Position | Ian Dunn (CHIEF PHYSICIAN EXECUTIVE) |
| Authorized Official Contact | 4052711515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1122 Ne 13th St Ste Ori 274 Oklahoma City OK 73117-1039 Ph: (405) 271-1515 | 105 S Bryant Ave Ste 404 Edmond OK 73034-6331 Ph: (405) 271-2663 |
| NPI Number | 1609450634 |
|---|---|
| Provider Enumeration Date | 05/06/2021 |
| Last Update Date | 02/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609450634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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