Provider Demographics
NPI:1740296060
Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-4250
Mailing Address - Street 1:1000 W WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7030
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-848-2525
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-842-4850
Practice Address - Fax:405-848-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty