Healthcare Provider Details

I. General information

NPI: 1326234584
Provider Name (Legal Business Name): NORMAN SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ROBINSON ST 2300
NORMAN OK
73071-6697
US

IV. Provider business mailing address

500 E ROBINSON ST 2300
NORMAN OK
73071-6697
US

V. Phone/Fax

Practice location:
  • Phone: 405-329-4102
  • Fax: 405-364-3476
Mailing address:
  • Phone: 405-329-4102
  • Fax: 405-364-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17833
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24274
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26881
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number9306
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0054197
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23363
License Number StateOK

VIII. Authorized Official

Name: MR. TOM SHI CONNALLY
Title or Position: MEMBER
Credential: MD
Phone: 405-329-4102