Organization
CEDAR RIDGE CLINIC,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRUNG H PHAM D.O. (PHYSICIAN)
(918) 459-0583
Entity
Organization
Contact information
Practice address
10016 S MINGO RD STE A, TULSA, OK 74133-5789
(918) 459-0583
(918) 250-0120
Mailing address
10016 S MINGO RD STE A, TULSA, OK 74133-5789
(918) 459-0583
(918) 250-0120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3313
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223040F
—
OK
Enumeration date
07/08/2010
Last updated
11/23/2010
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