Healthcare Provider Details

I. General information

NPI: 1932183548
Provider Name (Legal Business Name): PATRICK JOSEPH DALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PATRICK J DALEY M.D., P.C.

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1589 E 19TH ST
TULSA OK
74120-7629
US

IV. Provider business mailing address

1589 E 19TH ST
TULSA OK
74120-7629
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-8941
  • Fax: 918-744-4459
Mailing address:
  • Phone: 918-743-8941
  • Fax: 918-744-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12348
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: