Provider Demographics
NPI:1164938858
Name:PHP YUKON LLC
Entity Type:Organization
Organization Name:PHP YUKON LLC
Other - Org Name:PRIMARY HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-265-2778
Mailing Address - Street 1:1820 COMMONS CIR STE B
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9518
Mailing Address - Country:US
Mailing Address - Phone:405-265-2778
Mailing Address - Fax:405-494-7274
Practice Address - Street 1:1820 COMMONS CIR STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9518
Practice Address - Country:US
Practice Address - Phone:405-265-2778
Practice Address - Fax:405-494-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty