Healthcare Provider Details

I. General information

NPI: 1306818828
Provider Name (Legal Business Name): HAMPTON W ANDERSON III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

306 CAMPBELL ST
BROKEN BOW OK
74728-3142
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1189
Mailing address:
  • Phone: 580-584-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-24017
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: