Organization
ENID RADIOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MALONE (ADMINISTRATIVE MANAGER)
(405) 321-8125
Entity
Organization
Contact information
Practice address
305 S 5TH ST, ENID, OK 73701-5832
(580) 234-2878
Mailing address
PO BOX 1847, ENID, OK 73702-1847
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200090890A
—
OK
01
—
DE9049
RR MEDICARE
OK
Enumeration date
05/24/2006
Last updated
04/22/2008
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