# WINDSOR PARK MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104070259
- **Authorized official:** STACY LOUISE FAGAN P.A.C. (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (405) 605-5415

## Contact information

- **Practice address:** 2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
- **Practice address phone:** (405) 605-5415
- **Practice address fax:** (405) 605-5310
- **Mailing address:** 2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
- **Mailing address phone:** (405) 605-5415
- **Mailing address fax:** (405) 605-5310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1779 | OK | Yes |

## Other

- **Enumeration date:** 11/14/2008
- **Last updated:** 11/14/2008