Healthcare Provider Details

I. General information

NPI: 1336587088
Provider Name (Legal Business Name): TULSA CANCER INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12697 E. 51ST ST. SOUTH
TULSA OK
74146
US

IV. Provider business mailing address

12697 E. 51ST ST. SOUTH
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax:
Mailing address:
  • Phone: 918-505-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARON G. STREET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-505-3200