Organization
BOARD OF REGENTS OF THE UNIV OF OKLAHOMA-OU PHYSICIANS LATINO CLINIC
Active
Other names
OU Physicians Latino Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN MADDY (CHIEF EXECUTIVE OFFICER)
(405) 271-1515
Entity
Organization
Contact information
Practice address
420 SW 10, OKC, OK 73160
(405) 232-4160
Mailing address
1122 NE 13, ORI236, OKC, OK 73117
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744720X
—
OK
05
—
200284890A
—
OK
Enumeration date
10/03/2006
Last updated
05/12/2010
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