Healthcare Provider Details

I. General information

NPI: 1528248069
Provider Name (Legal Business Name): PHILIP S HATFIELD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W. ELGIN ST
BROKEN ARROW OK
74012
US

IV. Provider business mailing address

701 W. ELGIN ST
BROKEN ARROW OK
74012
US

V. Phone/Fax

Practice location:
  • Phone: 918-455-2001
  • Fax: 918-455-6330
Mailing address:
  • Phone: 918-455-2001
  • Fax: 918-301-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005340
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001075A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number296
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: