Healthcare Provider Details

I. General information

NPI: 1467157040
Provider Name (Legal Business Name): ACHYUT UPENDRA SOMPURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
NORMAN OK
73071-5305
US

IV. Provider business mailing address

769 SW 19TH ST APT 2304
MOORE OK
73160-2979
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-4880
  • Fax:
Mailing address:
  • Phone: 858-220-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number41469
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: