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Organization
SOUTHEASTERN OKLAHOMA SPORTS MEDICINE, PLLC
Active
Organization
SOUTHEASTERN OKLAHOMA SPORTS MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN K RICH M.D. (PRESIDENT)
(580) 924-1414
Entity
Organization
Contact information
Practice address
1705 N WASHINGTON AVE, SUITE C, DURANT, OK 74701-2100
(580) 924-1414
(580) 931-0300
Mailing address
1705 N WASHINGTON AVE, SUITE C, DURANT, OK 74701-2100
(580) 924-1414
(580) 931-0300
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
24887
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063436947
—
OK
01
—
24887
MEDICAL LICENSE
OR
Enumeration date
04/23/2010
Last updated
04/23/2010
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