Provider Demographics
NPI:1649006271
Name:CULLUM, AUSTIN M
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:M
Last Name:CULLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3750
Mailing Address - Country:US
Mailing Address - Phone:405-923-4727
Mailing Address - Fax:
Practice Address - Street 1:8508 NW 74TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3750
Practice Address - Country:US
Practice Address - Phone:405-923-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist