Organization
CENTRAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG W DINWIDDIE PHYSICIAN ASSISTANT (PRESIDENT)
(405) 771-4151
Entity
Organization
Contact information
Practice address
10701 POND MEADOW DR, OKLAHOMA CITY, OK 73151-9149
(405) 771-4151
(405) 771-4151
Mailing address
10701 POND MEADOW DR, OKLAHOMA CITY, OK 73151-9149
(405) 771-4151
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1037
OK
Other
Enumeration date
08/09/2010
Last updated
11/12/2010
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