Healthcare Provider Details

I. General information

NPI: 1518314939
Provider Name (Legal Business Name): MARY HINOJOS MAMUT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MAMUT

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 S YALE AVE
TULSA OK
74136-1930
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-495-2685
  • Fax: 918-495-2660
Mailing address:
  • Phone: 918-499-4855
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS16300
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number7230
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: