Individual
DR. VIJAY N PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 S BRYANT AVE, SUITE 200, EDMOND, OK 73034-6399
(405) 340-4937
(405) 341-3078
Mailing address
4401 W MEMORIAL RD, SUITE 140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
18818
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10097490A
—
OK
Enumeration date
08/12/2006
Last updated
05/20/2014
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