Basic Information
Provider Information
NPI: 1700864147
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOWELL
FirstName: H
MiddleName: SLADE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 N COUNTRY CLUB RD
Address2:  
City: ADA
State: OK
PostalCode: 748202847
CountryCode: US
TelephoneNumber: 5804214570
FaxNumber: 5804216210
Practice Location
Address1: 1001 N COUNTRY CLUB RD
Address2:  
City: ADA
State: OK
PostalCode: 748202847
CountryCode: US
TelephoneNumber: 5804214570
FaxNumber: 5804216210
Other Information
ProviderEnumerationDate: 01/05/2006
LastUpdateDate: 05/21/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X24232OKY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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