Healthcare Provider Details

I. General information

NPI: 1154718575
Provider Name (Legal Business Name): WILLIAM HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W EDISON
TULSA OK
74127
US

IV. Provider business mailing address

18314 E 48TH PLACE
TULSA OK
74134
US

V. Phone/Fax

Practice location:
  • Phone: 918-833-8400
  • Fax:
Mailing address:
  • Phone: 918-510-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberAT52
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: