Healthcare Provider Details

I. General information

NPI: 1104803956
Provider Name (Legal Business Name): INTER ID INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 S YALE AVE STE 812
TULSA OK
74136-8354
US

IV. Provider business mailing address

6565 S YALE AVE STE 812
TULSA OK
74136-8354
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9486
  • Fax: 918-494-9480
Mailing address:
  • Phone: 918-494-9486
  • Fax: 918-494-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DILLIER ROWLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 918-494-9486