Healthcare Provider Details

I. General information

NPI: 1205836244
Provider Name (Legal Business Name): T JEFFREY EMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS JEFFREY EMEL MD

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 301
TULSA OK
74136
US

IV. Provider business mailing address

2488 E 81ST ST STE 290
TULSA OK
74137-4265
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9300
  • Fax: 918-494-9355
Mailing address:
  • Phone: 918-494-9341
  • Fax: 918-494-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number12693
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: