Healthcare Provider Details

I. General information

NPI: 1972240570
Provider Name (Legal Business Name): SAMANTHA RAE HULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA RAE BROCKLEHURST MD

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD # 2400
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD # 2400
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8787
  • Fax: 405-271-8547
Mailing address:
  • Phone: 405-271-8787
  • Fax: 405-271-8547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39702
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: