Healthcare Provider Details

I. General information

NPI: 1689659823
Provider Name (Legal Business Name): ROGER PHIL BARTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-5491
  • Fax: 918-494-4589
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number333924
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number17654
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: