Organization
REGENERATION NATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ROADHOUSE (OWNER, AUTHORIZED OFFICIAL)
(918) 481-2772
Entity
Organization
Contact information
Practice address
6565 S YALE AVE STE 106, TULSA, OK 74136-8302
(918) 481-2772
Mailing address
6565 S YALE AVE, TULSA, OK 74136-8327
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/20/2019
Last updated
03/26/2024
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