Provider Demographics
NPI:1477833523
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Entity Type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC GASTROENTEROLOGY CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-5884
Mailing Address - Street 1:1200 N PHILLIPS AVE
Mailing Address - Street 2:SUITE 9500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 9500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-5884
Practice Address - Fax:405-271-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81001363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty