Individual
DR. NICKEY GLENN KNUTSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8100 S WALKER AVE, BLDG A, SUITE 230, OKLAHOMA CITY, OK 73139-9402
(405) 631-0481
(405) 631-9025
Mailing address
8100 S WALKER AVE, BLDG A, SUITE 230, OKLAHOMA CITY, OK 73139-9402
(405) 631-0481
(405) 631-9025
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
10530
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731135951001
BLUE CROSS/BLUE SHIELD
OK
Enumeration date
04/26/2006
Last updated
07/08/2007
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