Healthcare Provider Details

I. General information

NPI: 1558323030
Provider Name (Legal Business Name): VICTOR PALOMINO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N FRANKLIN ST STE 200
JENKS OK
74037-2490
US

IV. Provider business mailing address

2431 E 61ST ST STE 500
TULSA OK
74136-1208
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-6800
  • Fax: 918-582-6060
Mailing address:
  • Phone: 918-582-6800
  • Fax: 918-582-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4164
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: