Healthcare Provider Details

I. General information

NPI: 1831597152
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 S YALE AVE STE. 101
TULSA OK
74136-3311
US

IV. Provider business mailing address

6966 S UTICA AVE STE. 225
TULSA OK
74136-3903
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-6333
  • Fax: 918-493-9405
Mailing address:
  • Phone: 918-492-6333
  • Fax: 918-493-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT NEVIN
Title or Position: MEMEBER
Credential:
Phone: 918-492-6333