Healthcare Provider Details

I. General information

NPI: 1700362522
Provider Name (Legal Business Name): RAZEK GEORGES COUSSA MDCM, MPHIL, MENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5065
US

IV. Provider business mailing address

608 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5065
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6060
  • Fax: 405-271-1926
Mailing address:
  • Phone: 405-271-6060
  • Fax: 405-271-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.132491
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-45956
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number34604
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberND-45956
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberMD-45956
License Number StateIA
# 6
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number39114
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: