Healthcare Provider Details

I. General information

NPI: 1811494867
Provider Name (Legal Business Name): HAROON SOHAIL BUTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date: 11/16/2018
Reactivation Date: 11/28/2018

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-1418
  • Fax: 918-494-1491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number43140
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: