Provider Demographics
NPI:1124843388
Name:DURSO, ANDREW HARRIS
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HARRIS
Last Name:DURSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 S VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6249
Mailing Address - Country:US
Mailing Address - Phone:405-664-0679
Mailing Address - Fax:
Practice Address - Street 1:3000 SW 104TH ST STE 6
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7041
Practice Address - Country:US
Practice Address - Phone:405-698-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1362237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist