Healthcare Provider Details

I. General information

NPI: 1437906302
Provider Name (Legal Business Name): ADVANCED ORTHOPEDICS OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 W BLUE STARR DR STE 105
CLAREMORE OK
74017-2869
US

IV. Provider business mailing address

2488 E 81ST ST STE 290
TULSA OK
74137-4299
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-0600
  • Fax: 918-341-0604
Mailing address:
  • Phone: 918-494-2665
  • Fax: 918-927-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHON JAMES OZTURK
Title or Position: CFO
Credential:
Phone: 918-927-3214