Healthcare Provider Details

I. General information

NPI: 1497417067
Provider Name (Legal Business Name): OKLAHOMA INFECTIOUS DISEASE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

400 GALLERIA PKWY SE STE 1755
ATLANTA GA
30339-5934
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 404-500-8147
  • Fax:

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: BOYKIN ROBINSON
Title or Position: CEO
Credential: MD
Phone: 404-500-8147