Provider Demographics
NPI:1366489213
Name:DIGESTIVE DISEASE SPECIALISTS INC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-767-6630
Mailing Address - Street 1:PO BOX 7316
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7316
Mailing Address - Country:US
Mailing Address - Phone:405-767-6630
Mailing Address - Fax:405-767-1176
Practice Address - Street 1:5015 N PENNSYLVANIA AVE
Practice Address - Street 2:STE. 303
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8891
Practice Address - Country:US
Practice Address - Phone:405-767-6630
Practice Address - Fax:405-767-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty