Individual
GAUTAM DEHADRAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 N PORTER AVE, NORMAN, OK 73071-6404
(405) 307-1600
(405) 307-1604
Mailing address
PO BOX 1308, ATTENTION: MANAGED CARE, NORMAN, OK 73070-1308
(405) 307-1600
(405) 307-1604
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2003-0258
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200050770A
—
OK
Enumeration date
05/10/2006
Last updated
03/10/2009
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