Healthcare Provider Details

I. General information

NPI: 1023086329
Provider Name (Legal Business Name): JOHN R HOUCK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH STREET DEPARTMENT OF SURGERY
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST DEPARTMENT OF SURGERY
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-3409
  • Fax: 405-456-5952
Mailing address:
  • Phone: 405-456-3409
  • Fax: 405-456-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number17455
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number17455
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number17455
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: