MEDICARE: MARK STEVEN HAMRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	17578	OK

General Provider Information

NPI Number	:	1164428215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK STEVEN HAMRA M.D.

Provider Business Mailing Address
First Line	:	9913 S 87TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5593
Country	:	US
Telephone Number	:	918-250-0087
Fax Number	:	918-258-1266

Provider Business Practice Location Address
First Line	:	817 S ELM PL
Second Line	:	STE 107
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5369
Country	:	US
Telephone Number	:	918-259-3141
Fax Number	:	918-258-1266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	12/18/2022

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