Healthcare Provider Details

I. General information

NPI: 1477746691
Provider Name (Legal Business Name): WILLIAM L. BARRETT M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MONTE VISTA ST SUITE B
ADA OK
74820-4674
US

IV. Provider business mailing address

520 N MONTE VISTA ST SUITE B
ADA OK
74820-4674
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-6470
  • Fax: 580-421-6472
Mailing address:
  • Phone: 580-421-6470
  • Fax: 580-421-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23280
License Number StateOK

VIII. Authorized Official

Name: DR. WILLIAM L BARRETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 580-421-6470