Provider Demographics
NPI:1720336431
Name:NORMAN SURGICAL ARTS CENTER PLLC
Entity Type:Organization
Organization Name:NORMAN SURGICAL ARTS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:BRALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-364-6777
Mailing Address - Street 1:640 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3913
Mailing Address - Country:US
Mailing Address - Phone:405-364-6777
Mailing Address - Fax:405-364-6789
Practice Address - Street 1:640 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3913
Practice Address - Country:US
Practice Address - Phone:405-364-6777
Practice Address - Fax:405-364-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical