Healthcare Provider Details

I. General information

NPI: 1366434680
Provider Name (Legal Business Name): BERNARD MICHAEL TOUGAS JR. D.C, P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E RAY FINE BLVD
ROLAND OK
74954-5181
US

IV. Provider business mailing address

PO BOX 5437
FORT SMITH AR
72913-5437
US

V. Phone/Fax

Practice location:
  • Phone: 918-503-6235
  • Fax:
Mailing address:
  • Phone: 918-503-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1462
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3388
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1536
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: