Organization
OKLAHOMA PAIN MANAGEMENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN ROSS PORTER (OWNER)
(405) 360-4705
Entity
Organization
Contact information
Practice address
3601 NW 138TH ST, STE 200, OKLAHOMA CITY, OK 73134-2513
(405) 242-4100
(405) 775-9356
Mailing address
PO BOX 108835, OKLAHOMA CITY, OK 73101-8835
(405) 775-9350
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200123080A
—
OK
01
—
DG6361
MEDICARE RR
OK
Enumeration date
10/01/2007
Last updated
05/03/2022
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