Healthcare Provider Details

I. General information

NPI: 1891859856
Provider Name (Legal Business Name): MINDI MARIE BULL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BOISE CIR STE 150
BROKEN ARROW OK
74012-4906
US

IV. Provider business mailing address

800 W BOISE CIR STE 150
BROKEN ARROW OK
74012-4906
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-9150
  • Fax: 918-403-6323
Mailing address:
  • Phone: 918-994-9150
  • Fax: 918-403-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4384
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: