Provider Demographics
NPI:1366822298
Name:OKLAHOMA PAIN PHYSICIANS PC
Entity Type:Organization
Organization Name:OKLAHOMA PAIN PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTIZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:405-606-8950
Mailing Address - Street 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:BLDG 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-606-8950
Mailing Address - Fax:405-755-9113
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BLDG 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-606-8950
Practice Address - Fax:405-755-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27480208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200109590AMedicaid
OK27480OtherOKLAHOMA MEDICAL LICENSE
OKFJ1813535OtherDEA