Healthcare Provider Details

I. General information

NPI: 1316907363
Provider Name (Legal Business Name): HENRY M ASIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND AVE SUITE 395
OKLAHOMA CITY OK
73112-2082
US

IV. Provider business mailing address

5401 N. PORTLAND AVE. SUITE 395
OKLAHOMA CITY OK
73112-2089
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-8041
  • Fax: 405-947-8043
Mailing address:
  • Phone: 405-947-8041
  • Fax: 405-947-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number89
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: