Healthcare Provider Details

I. General information

NPI: 1174750749
Provider Name (Legal Business Name): MATTHEW JOSEPH COMSTOCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 S NORWOOD AVE STE 110
TULSA OK
74137-5509
US

IV. Provider business mailing address

11912 S NORWOOD AVE STE 205
TULSA OK
74137-5509
US

V. Phone/Fax

Practice location:
  • Phone: 918-943-5303
  • Fax:
Mailing address:
  • Phone: 918-943-5303
  • Fax: 918-943-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4892
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4892
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: