Healthcare Provider Details

I. General information

NPI: 1346311776
Provider Name (Legal Business Name): JEFFREY M. CALAVA D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 S OLYMPIA AVE STE 250
TULSA OK
74132-1827
US

IV. Provider business mailing address

6802 S OLYMPIA AVE STE 250
TULSA OK
74132-1827
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-6494
  • Fax: 918-481-6726
Mailing address:
  • Phone: 918-481-6494
  • Fax: 918-481-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3179
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number3179
License Number StateOK

VIII. Authorized Official

Name: DR. JEFFREY M CALAVA
Title or Position: CEO
Credential: D.O.
Phone: 918-481-6494