Provider Demographics
NPI:1700897501
Name:ARDMORE OBGYN, PLLC
Entity Type:Organization
Organization Name:ARDMORE OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-223-6134
Mailing Address - Street 1:1045 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1810
Mailing Address - Country:US
Mailing Address - Phone:580-223-6134
Mailing Address - Fax:580-223-5962
Practice Address - Street 1:1045 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-223-6134
Practice Address - Fax:580-223-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty