Healthcare Provider Details

I. General information

NPI: 1396082327
Provider Name (Legal Business Name): DARAN L. PARHAM, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E 19TH ST STE 401
TULSA OK
74104-5409
US

IV. Provider business mailing address

1725 E 19TH ST STE 401
TULSA OK
74104-5409
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-1413
  • Fax: 918-748-7511
Mailing address:
  • Phone: 918-749-1413
  • Fax: 918-749-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number19513
License Number StateOK

VIII. Authorized Official

Name: DARAN L PARHAM
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 918-749-1413