Unknown Individual – Pediatric Radiology Physician, NPI 1205804549
Pediatric Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1122, Northeast 13th Street, Oklahoma City, Oklahoma County, Oklahoma, 73117, United States
ORI236
OKLAHOMA CITY, OK 731171039
Phone: (405) 271-1515
Type: Mailing
Nicholson Tower, 940, Northeast 13th Street, Oklahoma City, Oklahoma County, Oklahoma, 73104, United States
4G4250
OKLAHOMA CITY, OK 731045008
Phone: (405) 271-5125
Fax: (405) 271-3462
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 73117)
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