Provider Demographics
NPI:1194751834
Name:BROKEN ARROW BONE AND JOINT SPECIALISTS, PC
Entity type:Organization
Organization Name:BROKEN ARROW BONE AND JOINT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-451-1100
Mailing Address - Street 1:2950 S ELM PL
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7877
Mailing Address - Country:US
Mailing Address - Phone:918-451-1100
Mailing Address - Fax:918-451-0082
Practice Address - Street 1:2950 S ELM PL
Practice Address - Street 2:SUITE 460
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7877
Practice Address - Country:US
Practice Address - Phone:918-451-1100
Practice Address - Fax:918-451-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty