Healthcare Provider Details

I. General information

NPI: 1609553502
Provider Name (Legal Business Name): AMMAAR ANWAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 NW 168TH CT
EDMOND OK
73012-6787
US

IV. Provider business mailing address

3008 NW 168TH CT
EDMOND OK
73012-6787
US

V. Phone/Fax

Practice location:
  • Phone: 580-799-6369
  • Fax:
Mailing address:
  • Phone: 580-799-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number58.035662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: