Provider Demographics
NPI:1306383849
Name:UROLOGY AFFILIATES OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:UROLOGY AFFILIATES OF OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:AXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-942-8545
Mailing Address - Street 1:5300 N GRAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5517
Mailing Address - Country:US
Mailing Address - Phone:405-942-8545
Mailing Address - Fax:
Practice Address - Street 1:5300 N GRAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5517
Practice Address - Country:US
Practice Address - Phone:405-942-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty