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General NPI Number Information
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NPI Number | 1538196399
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Entity Type | Individual
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Provider Name | FRANK A DESANDRE JR. M.D
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 12451 E 100TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4600
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Country | US
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Telephone | 918-274-5000
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Fax | 918-274-5117
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Provider Business Mailing Address
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Address Line | 12451 E 100TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4600
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Country | US
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Telephone | 918-274-5000
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Fax | 918-274-5117
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD0000034302
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License Number State | TN
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