Organization
ST JOSEPHS CANCER CENTER OF NORTHERN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD R GIBSON (MANAGER OPTION ONCOLOGY OKLAHOMA)
(949) 400-0058
Entity
Organization
Contact information
Practice address
609 VIRGINIA AVE, PONCA CITY, OK 74601
(580) 767-1300
(580) 767-1960
Mailing address
230 N MIDWEST BLVD, MIDWEST CITY, OK 73110
(580) 767-1300
(580) 767-1960
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200084810A
—
OK
Enumeration date
07/05/2006
Last updated
04/05/2012
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