1114980398 NPI number — WILLIAM B PARSONS D.O.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114980398 NPI number — WILLIAM B PARSONS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARSONS
Provider First Name:
WILLIAM
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114980398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 W MEMORIAL RD
Provider Second Line Business Mailing Address:
SUITE 141; ATTN: TERRI
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-936-5800
Provider Business Mailing Address Fax Number:
405-936-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 14TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73401-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-220-6630
Provider Business Practice Location Address Fax Number:
580-220-6772
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  2390 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19101 . This is a "OBNDD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 2390 . This is a "LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100118360A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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