Organization
REVIVE HORMONE CLINIC PLLC
Active
Other names
Revive Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST BYRON FOSTER II MD (MANAGER)
(405) 703-8882
Entity
Organization
Contact information
Practice address
13316 S WESTERN AVE, SUITE F, OKLAHOMA CITY, OK 73170-7302
(405) 703-8882
(405) 237-3799
Mailing address
13316 S WESTERN AVE, SUITE F, OKLAHOMA CITY, OK 73170-7302
(405) 703-8882
(405) 237-3799
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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