Healthcare Provider Details

I. General information

NPI: 1679947709
Provider Name (Legal Business Name): OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N STRONG BLVD
MCALESTER OK
74501-4206
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-0625
  • Fax: 918-423-0695
Mailing address:
  • Phone: 918-499-2141
  • Fax: 918-499-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARON G. STREET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-505-3200