Healthcare Provider Details

I. General information

NPI: 1578676938
Provider Name (Legal Business Name): ABBAS TOUGHANIPOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE STE 902
OKLAHOMA CITY OK
73103-2477
US

IV. Provider business mailing address

PO BOX 1371
LOWELL AR
72745-1371
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-2400
  • Fax: 405-601-2411
Mailing address:
  • Phone: 405-418-4500
  • Fax: 405-418-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21550
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: