Anderson, Russell Wayne

Anderson, Russell Wayne is an individual health care provider with primary practice located at 4500 S Garnett Rd Ste 919, Tulsa OK 74146-5229. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Anderson, Russell Wayne can be contacted via phone (918) 728-6145.

Contact Information

Primary practice address
4500 S Garnett Rd Ste 919 Tulsa OK 74146-5229
Phone: (918) 728-6145
Fax: (918) 728-6146
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 056948 Georgia
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 4498 Oklahoma

Profile Details

NPI number 1114939733
LBN Legal business name Anderson, Russell Wayne
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2006
Last updated Oct 30th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114939733 NPPES
Oklahoma MEDICAID 200115580A

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