Healthcare Provider Details

I. General information

NPI: 1023034824
Provider Name (Legal Business Name): G. BRYANT BOYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE STE 1003
TULSA OK
74136-8378
US

IV. Provider business mailing address

6565 S YALE AVE STE 1003
TULSA OK
74136-8378
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-9014
  • Fax: 918-496-9016
Mailing address:
  • Phone: 918-496-9014
  • Fax: 918-496-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9472
License Number StateOK

VIII. Authorized Official

Name: GEORGE BRYANT BOYD
Title or Position: OWNER
Credential: M.D.
Phone: 918-496-9014