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Organization

PONCA CITY PRIMARY CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. AHMAD S AGHA MD (PRESIDENT)
(580) 762-6100
Entity
Organization

Contact information

Practice address
417 FAIRVIEW AVE, PONCA CITY, OK 74601-1923
(580) 762-6100
(580) 762-6104
Mailing address
417 FAIRVIEW AVE, PONCA CITY, OK 74601-1923
(580) 762-6100
(580) 762-6104

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0050756
OK

Other

Enumeration date
09/28/2011
Last updated
09/28/2011
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