Provider Demographics
NPI:1124646971
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Entity type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUBIALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-1515
Mailing Address - Street 1:1122 NE 13TH ST # 274
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-1515
Mailing Address - Fax:405-271-1001
Practice Address - Street 1:105 S BRYANT AVE STE 404
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6331
Practice Address - Country:US
Practice Address - Phone:405-271-2663
Practice Address - Fax:405-271-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty