Individual
RUSSELL WAYNE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4500 S GARNETT RD, STE 919, TULSA, OK 74146-5229
(918) 728-6145
(918) 728-6146
Mailing address
4500 S GARNETT RD, STE 919, TULSA, OK 74146-5229
(918) 728-6145
(918) 728-6146
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
056948
GA
207P00000X
Emergency Medicine Physician
Primary
4498
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200115580A
—
OK
Enumeration date
08/12/2006
Last updated
10/30/2007
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