Healthcare Provider Details

I. General information

NPI: 1992103832
Provider Name (Legal Business Name): STEPHEN BRADLEY HOOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
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

PO BOX 5188
LONGVIEW TX
75608-5188
US

V. Phone/Fax

Practice location:
  • Phone: 800-939-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number114353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: