# NORTHEAST OKLAHOMA PHYSICIAN NETWORK INC

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

## Provider details

- **NPI number:** 1114283025
- **Authorized official:** RICHARD FERGUSON (CEO)
- **Authorized official phone:** (918) 477-5049

## Contact information

- **Practice address:** 1130 E LANSING ST, BROKEN ARROW, OK 74012-2429
- **Practice address phone:** (918) 258-9990
- **Practice address fax:** (918) 994-4277
- **Mailing address:** 2408 E 81ST ST, STE 300, TULSA, OK 74137-4200
- **Mailing address phone:** (918) 477-5049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 04/04/2012
- **Last updated:** 06/19/2012