Healthcare Provider Details

I. General information

NPI: 1306884812
Provider Name (Legal Business Name): ADULT GASTROENTEROLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 E SKELLY DR STE 700
TULSA OK
74135-3256
US

IV. Provider business mailing address

PO BOX 305
LOWELL AR
72745-0305
US

V. Phone/Fax

Practice location:
  • Phone: 918-438-7050
  • Fax: 918-221-0835
Mailing address:
  • Phone: 918-438-7050
  • Fax: 918-221-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS B KLIEWER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 918-481-4700