Healthcare Provider Details

I. General information

NPI: 1306891288
Provider Name (Legal Business Name): HARVARD FAMILY PHYSICIANS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7912 E 31ST CT SUITE 220
TULSA OK
74145-1315
US

IV. Provider business mailing address

7912 E 31ST CT SUITE 220
TULSA OK
74145-1315
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-8200
  • Fax:
Mailing address:
  • Phone: 918-743-8200
  • Fax: 918-743-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2623
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16314
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15800
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15691
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14483
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13762
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14337
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22222
License Number StateOK
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21221
License Number StateOK
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11366
License Number StateOK
# 11
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26464
License Number StateOK
# 12
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3713
License Number StateOK
# 13
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24064
License Number StateOK
# 14
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4733
License Number StateOK
# 15
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17805
License Number StateOK

VIII. Authorized Official

Name: DR. KENNETH ARTHUR MUCKALA
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 918-743-8200