Healthcare Provider Details

I. General information

NPI: 1689631533
Provider Name (Legal Business Name): JOHN ANTHONY YEABOWER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FRANK PHILLIPS BLVD
BARTLESVILLE OK
74006-2411
US

IV. Provider business mailing address

4500 S GARNETT RD STE 919
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-7200
  • Fax:
Mailing address:
  • Phone: 770-514-2773
  • Fax: 855-917-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16043
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: