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General NPI Number Information
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NPI Number | 1053676627
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Entity Type | Individual
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Provider Name | ANDRE LUIZ PITANGA BASTOS DE SOUZA M.D
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 800 NE 10TH ST STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5418
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Country | US
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Telephone | 405-271-4022
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Fax | 405-271-3020
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Provider Business Mailing Address
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Address Line | 515 CENTRAL PARK DR STE 5009
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-1724
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Country | US
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Telephone | 405-764-8066
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Fax | 405-271-1001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 46042
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD16354
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License Number State | RI
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