Healthcare Provider Details

I. General information

NPI: 1871032094
Provider Name (Legal Business Name): UNIVERSITY OF TULSA ALEXANDER HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S TUCKER DR
TULSA OK
74104-9700
US

IV. Provider business mailing address

800 S TUCKER DR
TULSA OK
74104-9700
US

V. Phone/Fax

Practice location:
  • Phone: 918-631-2241
  • Fax:
Mailing address:
  • Phone: 918-631-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5195
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5195
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2767
License Number StateOK

VIII. Authorized Official

Name: DR. KARA MARIE BEAIR BUTLER
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 918-631-2241