Healthcare Provider Details

I. General information

NPI: 1578890281
Provider Name (Legal Business Name): ARTHUR HAROLD HULBERT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S 33RD ST
MUSKOGEE OK
74401-5036
US

IV. Provider business mailing address

1409 SADDLEBROOKE
FORT GIBSON OK
74434-7529
US

V. Phone/Fax

Practice location:
  • Phone: 918-913-2623
  • Fax:
Mailing address:
  • Phone: 918-869-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: