NPI 1063790202

Eagle Community Clinic LLC

Organisation Family Medicine Physician Edmond, OK

Practice location

Address: 13800 Benson Rd 202, Edmond, OK 73013-6422
Phone: (405) 418-3077
Fax: (405) 418-3076
Mailing address: PO Box 5995, Norman, OK 73070-5995

Authorised official

Name: Brandon L Penick
Title: Director of Reimbursement
Phone: (405) 360-6764

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Oklahoma →

Registry record

NPI: 1063790202
Entity type: Organization
NPI issued: 21 Jul 2011
Record last updated: 21 Jul 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.