Provider Demographics
NPI:1912111238
Name:TROY R NORRED MD PC
Entity Type:Organization
Organization Name:TROY R NORRED MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-917-3528
Mailing Address - Street 1:3545 NW 58TH ST
Mailing Address - Street 2:STE 450
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4726
Mailing Address - Country:US
Mailing Address - Phone:580-272-0715
Mailing Address - Fax:580-272-0771
Practice Address - Street 1:3012 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3073
Practice Address - Country:US
Practice Address - Phone:405-948-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200732085N0904X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200111640AMedicaid
OK200111640AMedicaid