Self Provider Group

NPI #1134387855 in Alva, Oklahoma

Provider Information

NPI Number: 1134387855
Entity Type: Organization
Organization Name: Self Provider Group
Primary Specialty: Internal Medicine
Enumeration Date: May 29, 2008
Last Updated: May 29, 2008

Practice Location

Address: 410 4TH ST
Address 2: STE G
City: Alva
State: Oklahoma
ZIP Code: 73717-2372
Phone: (580) 327-5442

Authorized Official

Name: LISA M MCMURPHY, PHD
Title: PRACTICE MANAGER
Phone: (580) 327-5442

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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