Healthcare Provider Details

I. General information

NPI: 1609856350
Provider Name (Legal Business Name): THOMAS VAN NUNN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 S 101ST EAST AVE SUITE 280
TULSA OK
74133-5708
US

IV. Provider business mailing address

9001 S 101ST EAST AVE SUITE 280
TULSA OK
74133-5708
US

V. Phone/Fax

Practice location:
  • Phone: 918-459-8824
  • Fax: 918-307-2239
Mailing address:
  • Phone: 918-459-8824
  • Fax: 918-307-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2198
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: