Provider Demographics
NPI:1104919042
Name:THE ENDOCRINE GROUP
Entity type:Organization
Organization Name:THE ENDOCRINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-951-4160
Mailing Address - Street 1:PO BOX 25887
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0887
Mailing Address - Country:US
Mailing Address - Phone:405-951-4160
Mailing Address - Fax:405-951-4162
Practice Address - Street 1:5401 N PORTLAND
Practice Address - Street 2:STE 310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2082
Practice Address - Country:US
Practice Address - Phone:405-951-4160
Practice Address - Fax:405-951-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare PIN