Healthcare Provider Details

I. General information

NPI: 1093971236
Provider Name (Legal Business Name): ANTHONY R GUARIGLIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 SOUTH ERIE AVE.
TULSA OK
74136
US

IV. Provider business mailing address

6405 S ERIE AVE
TULSA OK
74136-2003
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-1996
  • Fax: 203-733-1996
Mailing address:
  • Phone: 203-733-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-07007
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: