Healthcare Provider Details

I. General information

NPI: 1922137926
Provider Name (Legal Business Name): GREGORY L MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N HARVARD SUITE B
TULSA OK
74115
US

IV. Provider business mailing address

1515 N HARVARD SUITE B
TULSA OK
74115
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-1901
  • Fax: 918-388-1902
Mailing address:
  • Phone: 918-388-1901
  • Fax: 918-388-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number16334
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: