Healthcare Provider Details

I. General information

NPI: 1821060716
Provider Name (Legal Business Name): BERNARD JAMES MAGUIRE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SHERIDAN RD
TULSA OK
74129
US

IV. Provider business mailing address

PO BOX 268838
OKLAHOMA CITY OK
73126-8838
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4300
  • Fax: 918-619-4322
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8272
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: