Healthcare Provider Details

I. General information

NPI: 1841260015
Provider Name (Legal Business Name): JOSEPH M. NICHOLSON III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 S UTICA AVE
TULSA OK
74104-4649
US

IV. Provider business mailing address

10231 S EVANSTON PL
TULSA OK
74137-5633
US

V. Phone/Fax

Practice location:
  • Phone: 918-551-2355
  • Fax: 918-551-2020
Mailing address:
  • Phone: 918-551-2355
  • Fax: 918-551-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3090
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3090
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: