Provider Demographics
NPI:1568985182
Name:FRALEY CLINIC PLLC
Entity Type:Organization
Organization Name:FRALEY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-471-5460
Mailing Address - Street 1:925 W I 35 FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7399
Mailing Address - Country:US
Mailing Address - Phone:405-601-6181
Mailing Address - Fax:405-601-7012
Practice Address - Street 1:925 W I 35 FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7399
Practice Address - Country:US
Practice Address - Phone:405-471-5460
Practice Address - Fax:405-471-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty