Healthcare Provider Details

I. General information

NPI: 1194844936
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 E 36TH ST N
TULSA OK
74106-1812
US

IV. Provider business mailing address

4502 E 41ST ST # 2G08 OU PHYSICIANS TULSA-CLINICAL SERVICES
TULSA OK
74135-2536
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-8700
  • Fax: 918-634-7884
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN JOINER
Title or Position: COO OU PHYSICIANS TULSA
Credential:
Phone: 918-660-3081