Healthcare Provider Details

I. General information

NPI: 1154382711
Provider Name (Legal Business Name): WILLIAM SURBECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 S 109TH EAST AVE STE. 200
TULSA OK
74146-5822
US

IV. Provider business mailing address

4812 S 109TH EAST AVE STE. 200
TULSA OK
74146-5822
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4567
  • Fax: 918-236-4578
Mailing address:
  • Phone: 918-236-4567
  • Fax: 918-236-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number16971
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: