Healthcare Provider Details

I. General information

NPI: 1831201441
Provider Name (Legal Business Name): ANGELA D HUFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

7908 E COMMERCIAL ST
BROKEN ARROW OK
74014-2683
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 918-806-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22672
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: