Organization
WINDSOR PARK MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY LOUISE FAGAN P.A.C. (PHYSICIAN ASSISTANT)
(405) 605-5415
Entity
Organization
Contact information
Practice address
2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
(405) 605-5415
(405) 605-5310
Mailing address
2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
(405) 605-5415
(405) 605-5310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1779
OK
Other
Enumeration date
11/14/2008
Last updated
11/14/2008
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