MEDICARE: MARK A CAPEHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	9763	OK
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	9763	OK
3	207XP3100X	Pediatric Orthopaedic Surgery Physician	9763	OK

General Provider Information

NPI Number	:	1235139379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A CAPEHART MD

Provider Business Mailing Address
First Line	:	6475 S YALE AVE
Second Line	:	STE 301
City	:	TULSA
State	:	OK
Zip	:	74136-7816
Country	:	US
Telephone Number	:	918-494-9300
Fax Number	:	918-494-9324

Provider Business Practice Location Address
First Line	:	6475 S YALE AVE
Second Line	:	STE 301
City	:	TULSA
State	:	OK
Zip	:	74136-7816
Country	:	US
Telephone Number	:	918-494-9300
Fax Number	:	918-494-9324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/14/2012

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Directions to “ MARK A CAPEHART MD” Practice Location

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