Healthcare Provider Details

I. General information

NPI: 1649614421
Provider Name (Legal Business Name): ANDREW PRINCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S UTICA AVE STE 302
TULSA OK
74104-4200
US

IV. Provider business mailing address

1245 S UTICA AVE STE 302
TULSA OK
74104-4200
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-2560
  • Fax:
Mailing address:
  • Phone: 918-382-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number6560
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number6560
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: