Healthcare Provider Details

I. General information

NPI: 1497803209
Provider Name (Legal Business Name): PETER AZUKA OKWUASABA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE SUITE 350
TULSA OK
74133-5726
US

IV. Provider business mailing address

8803 S 101ST EAST AVE SUITE 350
TULSA OK
74133-5726
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-3750
  • Fax:
Mailing address:
  • Phone: 918-615-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25303
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: