Healthcare Provider Details

I. General information

NPI: 1609830678
Provider Name (Legal Business Name): DAVID S SHOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7912 E 31ST CT SUITE 200
TULSA OK
74145-1315
US

IV. Provider business mailing address

7912 E 31ST CT SUITE 200
TULSA OK
74145-1315
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-8200
  • Fax: 918-743-8609
Mailing address:
  • Phone: 918-743-8200
  • Fax: 918-743-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11366
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: