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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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