Provider Demographics
NPI:1962061440
Name:SKIN CANCER CENTER, PLLC
Entity type:Organization
Organization Name:SKIN CANCER CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-865-4040
Mailing Address - Street 1:PO BOX 720067
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4051
Mailing Address - Country:US
Mailing Address - Phone:405-865-4040
Mailing Address - Fax:405-865-4041
Practice Address - Street 1:3209 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6738
Practice Address - Country:US
Practice Address - Phone:405-865-4040
Practice Address - Fax:405-865-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1104262526Medicaid