Healthcare Provider Details

I. General information

NPI: 1477639920
Provider Name (Legal Business Name): VICTORIA WILHELM BJORNSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9912 E 21ST ST
TULSA OK
74129-1620
US

IV. Provider business mailing address

9912 E 21ST ST
TULSA OK
74129-1620
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-0641
  • Fax: 918-622-0683
Mailing address:
  • Phone: 918-622-0641
  • Fax: 918-622-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4275
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: