Healthcare Provider Details

I. General information

NPI: 1710989900
Provider Name (Legal Business Name): EVAN D. COLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE STE 1220
TULSA OK
74136-8384
US

IV. Provider business mailing address

6585 S YALE AVE STE 1220
TULSA OK
74136-8384
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-4950
  • Fax: 918-502-4955
Mailing address:
  • Phone: 918-502-4950
  • Fax: 918-502-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3158
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number3158
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: