Provider Demographics
NPI:1689921207
Name:SOONER PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SOONER PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:REFAT ABDELAZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-926-0444
Mailing Address - Street 1:1218 E 9TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5796
Mailing Address - Country:US
Mailing Address - Phone:405-896-6777
Mailing Address - Fax:405-896-6725
Practice Address - Street 1:1218 E 9TH ST STE 1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5796
Practice Address - Country:US
Practice Address - Phone:405-896-6777
Practice Address - Fax:405-896-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK262762084P0800X, 2084P0800X
104100000X
OK24606207Q00000X
OK83243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200560830AMedicaid