Mobile Physician'S Office LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

13177 Issued in OK

Legal business name

MOBILE PHYSICIAN'S OFFICE LLC

Practice address

3941 N Pine Ave
Broken Arrow, OK 74012-0459

Phone

(918) 760-2200

Fax

(918) 615-6556

NPI assigned

Jun 1, 2011

Organization subpart

No

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

Authorized official

Name

Tandaleo Gamble, RN

Title

Ceo

Phone

(918) 760-2200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1700170222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3941 N PINE AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740120459",
            "telephone_number": "918-760-2200",
            "fax_number": "918-615-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3941 N PINE AVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740120459",
            "telephone_number": "918-760-2200",
            "fax_number": "918-615-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE PHYSICIAN'S OFFICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "TANDALEO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-760-2200",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "13177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelley Mitchell
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• Stacy Lynn Mitchell, LPC
• Tiffany E Mitchell, MS
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• Modern Mental Health
• Samirah Mohamad, DDS
• Shelby Nicole Mondloch, OTA/L
• Katherine Monette, DPH
• Robert Blaine Mongrain Jr., DMD

• Internal Medicine Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.