Healthcare Provider Details

I. General information

NPI: 1437296001
Provider Name (Legal Business Name): ANTON A SURJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

IV. Provider business mailing address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

V. Phone/Fax

Practice location:
  • Phone: 918-268-9578
  • Fax: 918-471-2854
Mailing address:
  • Phone: 918-268-9578
  • Fax: 918-471-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25371
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25371
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: