Healthcare Provider Details

I. General information

NPI: 1952692683
Provider Name (Legal Business Name): J E BLOCK, M.D., FACP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6048 S. SHERIDAN RD STE B
TULSA OK
74145
US

IV. Provider business mailing address

6048 S. SHERIDAN RD STE B
TULSA OK
74145
US

V. Phone/Fax

Practice location:
  • Phone: 918-591-3891
  • Fax: 918-895-7887
Mailing address:
  • Phone: 918-591-3891
  • Fax: 918-895-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY NIGHTINGALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-591-3891