Provider Demographics
NPI:1225101215
Name:HASBROOK, VIVIAN G (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:G
Last Name:HASBROOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5104
Mailing Address - Country:US
Mailing Address - Phone:405-424-7711
Mailing Address - Fax:405-307-4865
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:BLDG. 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5305
Practice Address - Country:US
Practice Address - Phone:405-307-4800
Practice Address - Fax:405-307-4865
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100205270AMedicaid
OKF87193Medicare UPIN
OK100205270AMedicaid
OK839017987 243501203Medicare ID - Type Unspecified