Healthcare Provider Details

I. General information

NPI: 1003092578
Provider Name (Legal Business Name): H. T. KURKJIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 713
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 713
OKLAHOMA CITY OK
73120-9350
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-2780
  • Fax: 405-608-0234
Mailing address:
  • Phone: 405-755-2780
  • Fax: 405-608-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number10422
License Number StateOK

VIII. Authorized Official

Name: DR. H T KURKJIAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 405-755-2780