Healthcare Provider Details

I. General information

NPI: 1962617613
Provider Name (Legal Business Name): AZAD DADGAR-DEHKORDI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 S YALE AVE STE 525
TULSA OK
74135
US

IV. Provider business mailing address

5110 S YALE AVE STE 525
TULSA OK
74135-7485
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4547
  • Fax: 918-392-4555
Mailing address:
  • Phone: 918-392-4547
  • Fax: 918-392-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number5325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: