Organization
DIGESTIVE DISEASE PATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL R DAVIS (ADMINISTRATOR)
(405) 767-6630
Entity
Organization
Contact information
Practice address
3366 NW EXPRESSWAY, SUITE 350, OKLAHOMA CITY, OK 73112-4462
(405) 767-6630
(405) 767-1176
Mailing address
5015 N PENN AVE, SUITE 303, OKLAHOMA CITY, OK 73112-8891
(405) 767-6630
(405) 767-1176
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37D1088518
CLIA NUMBER
OK
Enumeration date
10/23/2008
Last updated
10/23/2008
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