Healthcare Provider Details

I. General information

NPI: 1558328773
Provider Name (Legal Business Name): HUAN N VU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E. 79TH STREET
TULSA OK
74133
US

IV. Provider business mailing address

3506 21ST ST STE 601
LUBBOCK TX
79410-1234
US

V. Phone/Fax

Practice location:
  • Phone: 918-286-5000
  • Fax: 918-249-7532
Mailing address:
  • Phone: 918-286-5000
  • Fax: 918-246-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101236999
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number73195
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number32548
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberJ2401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: