Individual
RALPH EUGENE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114-7408
(405) 230-9000
(405) 230-9157
Mailing address
9600 BROADWAY EXT, OKLAHOMA CITY, OK 73114-7408
(405) 230-9000
(405) 230-9157
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA498
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000906304
—
OK
01
—
P00155699
RAILROAD MEDICARE
OK
Enumeration date
07/14/2005
Last updated
12/28/2017
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