Provider Demographics
NPI:1407180748
Name:SKIN SURGERY CENTER OF OKLAHOMA, P.C.
Entity Type:Organization
Organization Name:SKIN SURGERY CENTER OF OKLAHOMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:RHINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-947-6647
Mailing Address - Street 1:13100 N WESTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1432
Mailing Address - Country:US
Mailing Address - Phone:405-947-6647
Mailing Address - Fax:405-948-6647
Practice Address - Street 1:13100 N WESTERN AVE STE 301
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1432
Practice Address - Country:US
Practice Address - Phone:405-947-6647
Practice Address - Fax:405-948-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4552207N00000X
207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty