Provider Demographics
NPI:1104901875
Name:DR R G PATZKOWSKY PC
Entity type:Organization
Organization Name:DR R G PATZKOWSKY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:PATZKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-223-5432
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0309
Mailing Address - Country:US
Mailing Address - Phone:580-223-5432
Mailing Address - Fax:580-223-6076
Practice Address - Street 1:800 ISABEL
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-5432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1222208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09796Medicare UPIN