Organization
MIDLAND STATS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAUL PONCE (OWNER)
(405) 464-5918
Entity
Organization
Contact information
Practice address
3000 UNITED FOUNDERS BLVD, 225H, OKLAHOMA CITY, OK 73113-3958
(405) 464-5918
(918) 512-4441
Mailing address
3000 UNITED FOUNDERS BLVD, 225H, OKLAHOMA CITY, OK 73112-3958
(405) 464-5918
(918) 512-4441
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
OK
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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