1942680087 NPI number — DR. BLAIR AUSTIN KIRKPATRICK M.D.

Table of content: DR. BLAIR AUSTIN KIRKPATRICK M.D. (NPI 1942680087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942680087 NPI number — DR. BLAIR AUSTIN KIRKPATRICK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKPATRICK
Provider First Name:
BLAIR
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942680087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 CHILDRENS AVE
Provider Second Line Business Mailing Address:
OUCP 14000 A2
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-4417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N PORTER AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-366-8619
Provider Business Practice Location Address Fax Number:
405-366-1839
Provider Enumeration Date:
06/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 31641 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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