Organization
OKLAHOMA PAIN & REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM RYAN (OWNER)
(405) 926-7926
Entity
Organization
Contact information
Practice address
2149 SW 59TH ST, SUITE 201, OKLAHOMA CITY, OK 73119-7033
(405) 681-5800
Mailing address
2149 SW 59TH ST, SUITE 201, OKLAHOMA CITY, OK 73119-7033
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200388340A
—
OK
Enumeration date
04/18/2011
Last updated
05/21/2014
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