Healthcare Provider Details

I. General information

NPI: 1467839621
Provider Name (Legal Business Name): JULIAN T VEGA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW 32ND ST.
NEWCASTLE OK
73065
US

IV. Provider business mailing address

300 NW 32ND ST.
NEWCASTLE OK
73065
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-0450
  • Fax: 404-515-0451
Mailing address:
  • Phone: 405-515-0450
  • Fax: 405-515-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6114
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: