Provider Demographics
NPI:1235140633
Name:ROUSSEAU, ARTHUR WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WILLIAM
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9401 N KELLEY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-2441
Mailing Address - Country:US
Mailing Address - Phone:405-755-4700
Mailing Address - Fax:405-755-6900
Practice Address - Street 1:9401 N KELLEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-2441
Practice Address - Country:US
Practice Address - Phone:405-755-4700
Practice Address - Fax:405-755-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK134932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16506Medicare UPIN