Provider Demographics
NPI:1205868122
Name:HILL, EDWIN EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:EUGENE
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6425
Mailing Address - Country:US
Mailing Address - Phone:405-579-4111
Mailing Address - Fax:405-579-4223
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6425
Practice Address - Country:US
Practice Address - Phone:405-579-4111
Practice Address - Fax:405-579-4223
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK184852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF85869Medicare UPIN