Healthcare Provider Details

I. General information

NPI: 1487749891
Provider Name (Legal Business Name): WARREN L. POAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E 13TH ST STE 402
TULSA OK
74104-4431
US

IV. Provider business mailing address

1145 S UTICA AVE STE 110
TULSA OK
74104-4013
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-3855
  • Fax: 918-550-6565
Mailing address:
  • Phone: 918-579-2981
  • Fax: 918-579-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number44239
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: