Healthcare Provider Details

I. General information

NPI: 1134395940
Provider Name (Legal Business Name): J FREDERICK MCNEER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE STE 317
TULSA OK
74136-8344
US

IV. Provider business mailing address

6585 S YALE AVE STE 317
TULSA OK
74136-8344
US

V. Phone/Fax

Practice location:
  • Phone: 918-809-4304
  • Fax: 918-749-5456
Mailing address:
  • Phone: 918-809-4304
  • Fax: 918-749-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11650
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: J FREDERICK MCNEER
Title or Position: PRESIDENT
Credential: MD
Phone: 918-809-4304