Healthcare Provider Details

I. General information

NPI: 1174595599
Provider Name (Legal Business Name): MONTE D VEAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 S WESTERN AVE
OKLAHOMA CITY OK
73170-5819
US

IV. Provider business mailing address

11401 S WESTERN AVE
OKLAHOMA CITY OK
73170-5819
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-3041
  • Fax: 405-735-3146
Mailing address:
  • Phone: 405-735-3041
  • Fax: 405-735-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3795
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3795
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: