Healthcare Provider Details

I. General information

NPI: 1568881753
Provider Name (Legal Business Name): ADAM HARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST # 5D
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

3400 PRAIRIE GRASS RD
OKLAHOMA CITY OK
73120-5607
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-9493
  • Fax:
Mailing address:
  • Phone: 913-205-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberQ8900
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number38008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: