Provider Demographics
NPI:1659323517
Name:STURGEON, BOBBY ALFRED JR (DPH)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:ALFRED
Last Name:STURGEON
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-8041
Mailing Address - Country:US
Mailing Address - Phone:918-446-1404
Mailing Address - Fax:
Practice Address - Street 1:1507 W 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-8041
Practice Address - Country:US
Practice Address - Phone:918-446-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist