Healthcare Provider Details

I. General information

NPI: 1194353086
Provider Name (Legal Business Name): DIPA PUWAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 E 91ST ST
TULSA OK
74133-5834
US

IV. Provider business mailing address

10210 E 91ST ST
TULSA OK
74133-5834
US

V. Phone/Fax

Practice location:
  • Phone: 918-940-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7300
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: