Healthcare Provider Details

I. General information

NPI: 1174518336
Provider Name (Legal Business Name): PATRICK R VOLAK M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE SUITE 1002
TULSA OK
74136-7823
US

IV. Provider business mailing address

PO BOX 305
LOWELL AR
72745-0305
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-4700
  • Fax: 918-481-4765
Mailing address:
  • Phone: 918-481-4706
  • Fax: 918-481-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number15783
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: