Healthcare Provider Details

I. General information

NPI: 1407813587
Provider Name (Legal Business Name): AJAY KUMAR VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N PORTER AVE SUITE 208A
NORMAN OK
73071-6424
US

IV. Provider business mailing address

1901 PRESTON PL
EDMOND OK
73013-6524
US

V. Phone/Fax

Practice location:
  • Phone: 405-579-1444
  • Fax: 405-579-1448
Mailing address:
  • Phone: 405-359-2762
  • Fax: 405-348-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number21091
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: