Healthcare Provider Details

I. General information

NPI: 1700853801
Provider Name (Legal Business Name): BEHROOZ TOHIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 SW LEE BLVD SUITE 210
LAWTON OK
73505-9663
US

IV. Provider business mailing address

5606 SW LEE BLVD SUITE 205
LAWTON OK
73505-9663
US

V. Phone/Fax

Practice location:
  • Phone: 580-531-6476
  • Fax: 580-531-6491
Mailing address:
  • Phone: 580-531-6476
  • Fax: 580-531-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number021288
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: