Individual
TODD MICHAEL FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
21 NE 3RD ST, OKLAHOMA CITY, OK 73104-2205
(402) 486-7115
(402) 434-6047
Mailing address
21 NE 3RD ST, OKLAHOMA CITY, OK 73104-2205
(402) 486-7115
(402) 434-6047
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0046631
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100782930A
—
OK
Enumeration date
09/25/2006
Last updated
02/18/2021
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