Healthcare Provider Details

I. General information

NPI: 1649249525
Provider Name (Legal Business Name): TRUDY J MILNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 GRANDVIEW AVE
PAWHUSKA OK
74056-3201
US

IV. Provider business mailing address

1919 S WHEELING AVE LL 100
TULSA OK
74104-5638
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-9300
  • Fax: 918-287-6138
Mailing address:
  • Phone: 918-748-7890
  • Fax: 918-293-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2801
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: