| |
5050 E Kenosha Broken Arrow OK 74014 | |
(918) 355-9492 | |
(918) 355-9250 |
Full Name | |
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Speciality | Family Medicine |
Location | 5050 E Kenosha, Broken Arrow, Oklahoma |
Authorized Official Name and Position | Robert Jeffrey Wright (OWNER) |
Authorized Official Contact | 9183559492 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5050 E Kenosha Broken Arrow OK 74014 Ph: (918) 355-9492 | 5050 E Kenosha Broken Arrow OK 74014 Ph: (918) 355-9492 |
NPI Number | 1881629020 |
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Provider Enumeration Date | 07/12/2006 |
Last Update Date | 01/11/2011 |
Identifier | Type | State | Issuer |
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1881629020 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | OK1989 (Oklahoma) | Primary |
207Q00000X | Family Medicine | 1989 (Oklahoma) | Secondary |
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