Organization
MIDWEST MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE ANDERSON (OFFICE MANAGER)
(405) 739-6840
Entity
Organization
Contact information
Practice address
1201 S DOUGLAS BLVD, SUITE J, MIDWEST CITY, OK 73130-5239
(405) 739-6840
(405) 732-7149
Mailing address
1201 S DOUGLAS BLVD, SUITE J, MIDWEST CITY, OK 73130-5239
(405) 739-6840
(405) 732-7149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100700490B
—
OK
01
—
375659300
DEPT OF LABOR FECA
OK
Enumeration date
12/22/2005
Last updated
12/11/2014
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