Healthcare Provider Details

I. General information

NPI: 1508131509
Provider Name (Legal Business Name): DAVID CHARLES REMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID CHARLES REMESNITSKY

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2536
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2630
  • Fax:
Mailing address:
  • Phone: 918-579-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH66763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA167477
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36075
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: