Provider Demographics
NPI:1922014588
Name:OKLAHOMA FOUNDATION FOR DIGESTIVE RESEARCH
Entity Type:Organization
Organization Name:OKLAHOMA FOUNDATION FOR DIGESTIVE RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:MINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-4644
Mailing Address - Street 1:1000 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-281-4644
Mailing Address - Fax:405-271-3296
Practice Address - Street 1:1000 N LINCOLN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-281-4644
Practice Address - Fax:405-271-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty