Organization
DOCOK1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE LEMOINE MAXWELL (DIRECTOR OF PRACTICE DEVELOPMENT)
(214) 983-0303
Entity
Organization
Contact information
Practice address
3130 SW 89TH ST STE 200E, OKLAHOMA CITY, OK 73159-7908
(405) 673-3280
Mailing address
5040 ADDISON CIR STE 400, ADDISON, TX 75001-6049
(214) 983-0303
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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