Provider Demographics
NPI:1194572495
Name:HILLBOLT, WARREN DEAN III
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:DEAN
Last Name:HILLBOLT
Suffix:III
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 1:2317 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-2005
Mailing Address - Country:US
Mailing Address - Phone:405-978-4543
Mailing Address - Fax:
Practice Address - Street 1:2317 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-2005
Practice Address - Country:US
Practice Address - Phone:405-978-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist