Basic Information
Provider Information | |||||||||
NPI: | 1033269691 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BOARD OF REGENTS OF THE UNIVERSITY OF OKLHOAMA OU PHYSICIANS TULSA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
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OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4502 E 41ST ST # 2G08 | ||||||||
Address2: | OU PHYSICIANS TULSA-CLINICAL SERVICES | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741352553 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9186603632 | ||||||||
FaxNumber: | 9186603631 | ||||||||
Practice Location | |||||||||
Address1: | 1145 S UTICA AVE | ||||||||
Address2: | STE 202 | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741044000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185793130 | ||||||||
FaxNumber: | 9185793139 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/12/2007 | ||||||||
LastUpdateDate: | 11/10/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JOINER | ||||||||
AuthorizedOfficialFirstName: | JONATHAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
AuthorizedOfficialTelephone: | 9186603081 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |   |
No ID Information.