Healthcare Provider Details

I. General information

NPI: 1689616948
Provider Name (Legal Business Name): SOONER RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 W GORE BLVD SUITE 3
LAWTON OK
73505-6034
US

IV. Provider business mailing address

PO BOX 6220
LAWTON OK
73506
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-9300
  • Fax: 580-536-7900
Mailing address:
  • Phone: 580-536-9300
  • Fax: 580-536-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD DALE HARPER
Title or Position: PRESIDENT
Credential: MD
Phone: 580-536-9300