Healthcare Provider Details

I. General information

NPI: 1982141362
Provider Name (Legal Business Name): ALLISON ELDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 E 46TH PL
TULSA OK
74145-6305
US

IV. Provider business mailing address

7477 E 46TH PL
TULSA OK
74145-6305
US

V. Phone/Fax

Practice location:
  • Phone: 918-384-0002
  • Fax: 918-338-4000
Mailing address:
  • Phone: 918-384-0002
  • Fax: 918-338-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2763
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: