Healthcare Provider Details

I. General information

NPI: 1366373300
Provider Name (Legal Business Name): OKLAHOMA SHOULDER SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12806 E 101ST PL N STE 2
OWASSO OK
74055-4662
US

IV. Provider business mailing address

1175 S ASPEN AVE STE K
BROKEN ARROW OK
74012-4800
US

V. Phone/Fax

Practice location:
  • Phone: 918-965-2236
  • Fax:
Mailing address:
  • Phone: 833-524-2400
  • Fax: 918-290-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANYA J JULSON
Title or Position: PHYSICIAN/MEMBER
Credential:
Phone: 918-798-4802