Organization
BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU MARY MAHONEY
Active
Other names
OU Physicians Mary Mahoney
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN MADDY (CHIEF EXECUTIVE OFFICER)
(405) 271-1515
Entity
Organization
Contact information
Practice address
12716 NE 36TH STREET, OKLAHOMA CITY, OK 73140
(405) 769-3301
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744720D
—
OK
Enumeration date
04/20/2007
Last updated
09/28/2009
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