Provider Demographics
NPI:1679645055
Name:NORMAN UROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NORMAN UROLOGY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:S.
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-360-9966
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-360-9966
Mailing Address - Fax:405-360-9905
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-360-9966
Practice Address - Fax:405-360-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK142892088P0231X
OK132452088P0231X
OKPAC12342088P0231X
OK165182088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125830AMedicaid
OK100095640AMedicaid
OK10012080AMedicaid
OK100095640AMedicaid
OK100125830AMedicaid
OKE11804Medicare UPIN
OK24341002Medicare ID - Type UnspecifiedCLIFTON L. WHITESELL, MD
OKC95648Medicare UPIN
OK248309401Medicare ID - Type UnspecifiedKENT BAYS, PA-C
OK446743478Medicare ID - Type UnspecifiedPHILIP L. JONES, MD
OK446563915Medicare ID - Type UnspecifiedS. EDWARD DAKIL, MD