Healthcare Provider Details

I. General information

NPI: 1639487499
Provider Name (Legal Business Name): SPENCER EDWARD VOTH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 401
TULSA OK
74136-7818
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-9555
  • Fax: 918-502-9559
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number0S014660
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5285
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: