Healthcare Provider Details

I. General information

NPI: 1306823828
Provider Name (Legal Business Name): WAYNE A HUEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E MAIN ST
TUTTLE OK
73089-9171
US

IV. Provider business mailing address

BOX 580
TUTTLE OK
73089
US

V. Phone/Fax

Practice location:
  • Phone: 405-381-2301
  • Fax: 405-381-3592
Mailing address:
  • Phone: 405-381-2301
  • Fax: 405-381-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1703
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: