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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