Provider Demographics
NPI:1770814121
Name:UNIVERSITY OF OKLAHOMA
Entity Type:Organization
Organization Name:UNIVERSITY OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEHCHEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-869-3212
Mailing Address - Street 1:450 W 7TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-1046
Mailing Address - Country:US
Mailing Address - Phone:310-869-3212
Mailing Address - Fax:
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-9923
Practice Address - Country:US
Practice Address - Phone:918-660-8359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27022282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen