Healthcare Provider Details

I. General information

NPI: 1124969449
Provider Name (Legal Business Name): DANIEL JUDSON PHILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 137TH WEST AVE
SAND SPRINGS OK
74063-5017
US

IV. Provider business mailing address

2540 E 7TH ST APT 7
TULSA OK
74104-3353
US

V. Phone/Fax

Practice location:
  • Phone: 918-245-0231
  • Fax:
Mailing address:
  • Phone: 918-978-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: