Basic Information
Provider Information | |||||||||
NPI: | 1942281373 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | W ROBERT HOWARD MD INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 11/11/2005 | ||||||||
LastUpdateDate: | 11/05/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOWARD | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | ROBERT | ||||||||
AuthorizedOfficialTitleorPosition: | OWNERPHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 5807628324 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | II | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 10717 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |   |
ID Information
ID | Type | State | Issuer | Description | 582628 | 01 | KS | BCBS-KS | OTHER | 511446224-001 | 01 | OK | BCBS | OTHER |