Healthcare Provider Details

I. General information

NPI: 1235344557
Provider Name (Legal Business Name): TULSA PULMONARY AND ALLERGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 EAST 19TH ST SUITE 200
TULSA OK
74104-5418
US

IV. Provider business mailing address

1725 EAST 19TH ST SUITE 200
TULSA OK
74104-5418
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-8381
  • Fax: 918-748-8397
Mailing address:
  • Phone: 918-748-8381
  • Fax: 918-748-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD NEUL PLOST
Title or Position: PRESIDENT
Credential: MD
Phone: 918-748-8381