Healthcare Provider Details

I. General information

NPI: 1740277318
Provider Name (Legal Business Name): CONSULTING ANESTHESIOLOGY OF NORMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 WILL ROGERS PKWY SUITE 105
OKLAHOMA CITY OK
73108-1837
US

IV. Provider business mailing address

PO BOX 271086
OKLAHOMA CITY OK
73126-1086
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-8585
  • Fax: 405-948-6507
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 Number18211
License Number StateOK

VIII. Authorized Official

Name: CAMPBELL GILLESPIE III
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 405-947-8585