Healthcare Provider Details

I. General information

NPI: 1700953338
Provider Name (Legal Business Name): JUDY MARKS-SNELLING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 S SHERIDAN RD 416
TULSA OK
74145-5750
US

IV. Provider business mailing address

4833 S SHERIDAN RD 416
TULSA OK
74145-5750
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-3187
  • Fax: 918-491-9925
Mailing address:
  • Phone: 918-749-3187
  • Fax: 918-491-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2649
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2649
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: