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Organization

SPINE TRANSFORMATION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DERECK AARON PEERY DO (PRESIDENT/OWNER)
(580) 223-7200
Entity
Organization

Contact information

Practice address
915 10TH AVE NW, ARDMORE, OK 73401-4025
(580) 223-7200
(580) 223-7207
Mailing address
915 10TH AVE NW, ARDMORE, OK 73401-4025
(580) 223-7200
(580) 223-7207

Taxonomy

Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
4546
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200204540A
OK
Enumeration date
07/18/2008
Last updated
11/10/2010
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