Healthcare Provider Details

I. General information

NPI: 1659631448
Provider Name (Legal Business Name): ADAM HUSKERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WINDSOR DR
STILLWATER OK
74074-6962
US

IV. Provider business mailing address

PO BOX 720006
NORMAN OK
73070-4006
US

V. Phone/Fax

Practice location:
  • Phone: 405-707-0900
  • Fax: 405-707-3363
Mailing address:
  • Phone: 405-707-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number29229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: