Healthcare Provider Details

I. General information

NPI: 1942290788
Provider Name (Legal Business Name): ULYSSES S BOWLER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 N MARTIN LUTHER KING JR BLVD
TULSA OK
74106-6447
US

IV. Provider business mailing address

3606 N MARTIN LUTHER KING JR BLVD
TULSA OK
74106-6447
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-3536
  • Fax:
Mailing address:
  • Phone: 918-794-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13177
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13177
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: