Healthcare Provider Details

I. General information

NPI: 1659316438
Provider Name (Legal Business Name): DAVID BRIAN RALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6528 E 101ST ST STE D-1, PMB#419
TULSA OK
74133-6724
US

IV. Provider business mailing address

7779 E 106TH ST
TULSA OK
74133-6844
US

V. Phone/Fax

Practice location:
  • Phone: 918-398-7170
  • Fax: 918-398-7199
Mailing address:
  • Phone: 918-398-7170
  • Fax: 918-398-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20582
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: