Basic Information
| Provider Information | |||||||||
| NPI: | 1316008675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 FAIRVIEW AVE | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | PONCA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 746011920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807628324 | ||||||||
| FaxNumber: | 5807622581 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 FAIRVIEW AVE | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | PONCA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 746011920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807628324 | ||||||||
| FaxNumber: | 5807622581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | OK10717 | OK | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 582628 | 01 | KS | BCBS-KS | OTHER |