Individual
MICHAEL SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 270-0501
Mailing address
3913 BRIDLE PATH RD., YUKON, OK 73099
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA262
OK
Other
Enumeration date
10/31/2006
Last updated
07/08/2007
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