Provider Demographics
NPI:1396018735
Name:PHYSICIANS CENTER FOR WEIGHT MANAGEMENT, INC
Entity Type:Organization
Organization Name:PHYSICIANS CENTER FOR WEIGHT MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-632-0111
Mailing Address - Street 1:7249 S WESTERN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2011
Mailing Address - Country:US
Mailing Address - Phone:405-632-0111
Mailing Address - Fax:405-632-8225
Practice Address - Street 1:7249 S WESTERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2011
Practice Address - Country:US
Practice Address - Phone:405-632-0111
Practice Address - Fax:405-632-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12308207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100192030AMedicaid
OKD34667Medicare UPIN