Healthcare Provider Details

I. General information

NPI: 1053784934
Provider Name (Legal Business Name): REGGIE VULGAMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 N MCARTHUR BLVD APT 1811
OKLAHOMA CITY OK
73142-3056
US

IV. Provider business mailing address

12301 N MCARTHUR BLVD APT 1811
OKLAHOMA CITY OK
73142-3056
US

V. Phone/Fax

Practice location:
  • Phone: 405-706-2023
  • Fax:
Mailing address:
  • Phone: 405-706-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: