Organization
SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MALONE (PRACTICE DIRECTOR)
(405) 737-8455
Entity
Organization
Contact information
Practice address
230 N MIDWEST BLVD, MIDWEST CITY, OK 73110-4321
(405) 737-8455
Mailing address
230 N MIDWEST BLVD, MIDWEST CITY, OK 73110-4321
(405) 737-8455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747340A
—
OK
01
—
121446
MEDICARE GROUP HIGHMARK
PA
Enumeration date
05/09/2006
Last updated
08/10/2012
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