Healthcare Provider Details

I. General information

NPI: 1922851104
Provider Name (Legal Business Name): JOSHUA C BERTOLDIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2536
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2536
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: