NPIMap

Organization Active NPI

Premiere Pediatrics PLLC

  • Pediatrics Physician
  • Norman, OK
National Provider Identifier
1043354228
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PREMIERE PEDIATRICS PLLC
Practice address
3261 24TH Ave NW Ste 101
Norman, OK 73069-6666
Phone
(405) 364-6432
Fax
(405) 364-0090
NPI assigned
Feb 19, 2007
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Glen Diaz, APRNNPI 1780773952
Title
Officer
Phone
(405) 364-6432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3261 24TH Ave NW Ste 101
Norman, OK 73069-6666

Mailing address

3261 24TH Ave NW Ste 101
Norman, OK 73069-6666
Phone (405) 364-6432

Other practice location 1

3217 24th Avenue
Suite 103
Norm, OK 73069
Phone (405) 364-6432

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0469916Premiere Pediatrics3261 24TH Ave NW Suite 101, Norman, OK 73069Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory

Locations

3217 24th Ave NW
Ste 103
Norman, OK 73069
Phone (405) 364-6432

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1043354228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 24TH AVE NW STE 101",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696666",
            "telephone_number": "405-364-6432",
            "fax_number": "405-364-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 24TH AVE NW STE 101",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696666",
            "telephone_number": "405-364-6432",
            "fax_number": "405-364-0090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3217 24th Avenue",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Norm",
            "state": "OK",
            "postal_code": "73069",
            "country_code": "US",
            "telephone_number": "405-364-6432",
            "fax_number": "405-364-0090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIERE PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "405-364-6432",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.