Provider Demographics
NPI:1649518564
Name:OKLAHOMA PAIN PHYSICIANS PC
Entity type:Organization
Organization Name:OKLAHOMA PAIN PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTIZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:405-657-4800
Mailing Address - Street 1:PO BOX 268953
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8953
Mailing Address - Country:US
Mailing Address - Phone:405-657-4800
Mailing Address - Fax:405-396-3364
Practice Address - Street 1:1500 N GREEN AVE
Practice Address - Street 2:#106
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1642
Practice Address - Country:US
Practice Address - Phone:405-657-4800
Practice Address - Fax:405-396-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27480208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty