MEDICARE: W ROBERT HOWARD MD INC

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	207Y00000X	Otolaryngology Physician	10717	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582628	OTHER	KS	BCBS-KS
2	511446224-001	OTHER	OK	BCBS

General Provider Information

NPI Number	:	1942281373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W ROBERT HOWARD MD INC

Provider Business Mailing Address
First Line	:	400 FAIRVIEW AVE
Second Line	:	SUITE 16
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1920
Country	:	US
Telephone Number	:	580-762-8324
Fax Number	:	580-762-2581

Provider Business Practice Location Address
First Line	:	400 FAIRVIEW AVE
Second Line	:	SUITE 16
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1920
Country	:	US
Telephone Number	:	580-762-8324
Fax Number	:	580-762-2581

Authorized Official
Title or Position	:	OWNERPHYSICIAN
Name	:	DR. WILLIAM ROBERT HOWARD II
Credential	:	M.D.
Telephone Number	:	580-762-8324

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	11/05/2007

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