Basic Information
Provider Information
NPI: 1245217868
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARKERT
FirstName: KARL
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1705 E 19TH ST
Address2: SUITE 302
City: TULSA
State: OK
PostalCode: 741045405
CountryCode: US
TelephoneNumber: 9187487585
FaxNumber:  
Practice Location
Address1: 1705 E 19TH ST
Address2: SUITE 302
City: TULSA
State: OK
PostalCode: 741045405
CountryCode: US
TelephoneNumber: 9187487585
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/23/2005
LastUpdateDate: 05/05/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004X4097OKY Allopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services

No ID Information.


Home