Basic Information
| Provider Information | |||||||||
| NPI: | 1124365317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM TODD DUPLER, CRNA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4108 OLD POND CT | ||||||||
| Address2: | |||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731605431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057032309 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9801 S PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056921222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2013 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | DUPLER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | TODD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4057032309 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 64922 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.