Healthcare Provider Details

I. General information

NPI: 1629091640
Provider Name (Legal Business Name): JOHN FELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 S ELLIOTT ST
PRYOR OK
74361-6411
US

IV. Provider business mailing address

1145 S UTICA AVE SUITE 110
TULSA OK
74104-4000
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-3389
  • Fax: 918-825-5505
Mailing address:
  • Phone: 918-579-3825
  • Fax: 918-579-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3804
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: