Organization
PREMIER PEDIATRIC AND ADOLESCENT CARE OF BIXBY
Active
Organization
PREMIER PEDIATRIC AND ADOLESCENT CARE OF BIXBY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN MUNDY MD (OWNER)
(918) 943-5777
Entity
Organization
Contact information
Practice address
7814 E 121ST ST, BIXBY, OK 74008
(918) 943-5777
Mailing address
5913 E 108TH ST, TULSA, OK 74137-7057
(918) 853-2710
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
03/12/2020
Last updated
03/13/2020
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