Healthcare Provider Details

I. General information

NPI: 1316981848
Provider Name (Legal Business Name): YANCY JON GALUTIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/26/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 N 137TH E AVE
COLLINSVILLE OK
74021
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-2247
  • Fax: 918-272-6185
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4188
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: