Provider Demographics
NPI:1861504490
Name:VASCULAR ASSOCIATES OF SOUTHERN OKLAHOMA
Entity Type:Organization
Organization Name:VASCULAR ASSOCIATES OF SOUTHERN OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRITT
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-223-3216
Mailing Address - Street 1:PO BOX 25885
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0885
Mailing Address - Country:US
Mailing Address - Phone:580-223-3216
Mailing Address - Fax:580-223-4184
Practice Address - Street 1:2002 12TH AVE NW STE E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-223-3216
Practice Address - Fax:580-223-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty