Healthcare Provider Details

I. General information

NPI: 1003875469
Provider Name (Legal Business Name): NORTHWEST ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY 2ND FLOOR, DEPARTMENT OF ANESTHESIOLOGY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

PO BOX 26168
OKLAHOMA CITY OK
73126-0168
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-2815
  • Fax: 405-951-2495
Mailing address:
  • Phone: 405-947-8585
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY J GAWEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 405-947-5557