Organization
CENTRAL PA, LLC
Active
Organization
CENTRAL PA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY DINWIDDIE P.A. (MANAGING MEMBER)
(405) 601-0954
Entity
Organization
Contact information
Practice address
3601 N MAY AVE, SUITE C, OKLAHOMA CITY, OK 73112-6641
(405) 601-0954
(405) 601-3750
Mailing address
10701 POND MEADOW DR, OKLAHOMA CITY, OK 73151-9149
(405) 601-0954
(405) 601-3750
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1037
OK
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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