Provider Demographics
NPI:1346786308
Name:PEDIATRIC ENT OF OKLAHOMA PLLC
Entity Type:Organization
Organization Name:PEDIATRIC ENT OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DIGOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-608-8833
Mailing Address - Street 1:8908 S YALE AVE STE 100
Mailing Address - Street 2:LOCKBOX 52
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3561
Mailing Address - Country:US
Mailing Address - Phone:405-608-8833
Mailing Address - Fax:405-608-8818
Practice Address - Street 1:9900 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6323
Practice Address - Country:US
Practice Address - Phone:405-608-8833
Practice Address - Fax:405-608-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty