Provider Demographics
NPI:1518923564
Name:VANHOOSER, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VANHOOSER
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:PO BOX 844737
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4737
Mailing Address - Country:US
Mailing Address - Phone:580-249-3931
Mailing Address - Fax:580-249-3773
Practice Address - Street 1:316 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5622
Practice Address - Country:US
Practice Address - Phone:580-249-3931
Practice Address - Fax:580-249-3773
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK164882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00329370OtherRR MEDICARE
OK100155490AMedicaid
OK380596YPW9Medicare PIN
OKE34893Medicare UPIN
OK248516203Medicare PIN