Healthcare Provider Details

I. General information

NPI: 1104180553
Provider Name (Legal Business Name): AJAY JOSEPH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2012
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE STE 1304
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-5300
  • Fax: 918-494-5455
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number34350
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: