Basic Information
| Provider Information | |||||||||
| NPI: | 1952681728 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPARDOIN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3280 MARSHALL AVE | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730728022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055795858 | ||||||||
| FaxNumber: | 4052921787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3280 MARSHALL AVE | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730728022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055795858 | ||||||||
| FaxNumber: | 4052921787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 05/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | ARDOIN | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4058088211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 17730 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.