Healthcare Provider Details

I. General information

NPI: 1265552384
Provider Name (Legal Business Name): MARION MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 E 51ST ST
TULSA OK
74135-3657
US

IV. Provider business mailing address

3808 E 51ST ST
TULSA OK
74135-3657
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-3797
  • Fax: 918-749-1536
Mailing address:
  • Phone: 918-749-3797
  • Fax: 918-749-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2087
License Number StateOK

VIII. Authorized Official

Name: DR. MICHAEL KIM TAYLOR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-749-3797