Provider Demographics
NPI:1689874992
Name:HUSEN, ALFRED CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:CHARLES
Last Name:HUSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17209 PICASSO DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6607
Mailing Address - Country:US
Mailing Address - Phone:405-761-9421
Mailing Address - Fax:
Practice Address - Street 1:17209 PICASSO DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-6607
Practice Address - Country:US
Practice Address - Phone:405-761-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4527207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200122210AMedicaid
OKOK401723Medicare PIN