Organization
WELLNESS AND LONGEVITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL D ROTHWELL M.D. (MANAGING MEMBER)
(405) 787-8556
Entity
Organization
Contact information
Practice address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8556
Mailing address
7530 NW 23RD ST, BETHANY, OK 73008-4921
(405) 787-8556
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
10533
OK
207Q00000X
Family Medicine Physician
Primary
10533
OK
208D00000X
General Practice Physician
10533
OK
Other
Enumeration date
10/26/2009
Last updated
10/26/2009
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