Healthcare Provider Details

I. General information

NPI: 1437149457
Provider Name (Legal Business Name): JAMES ROY GEURIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

PO BOX 21228 DEPT 18
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3496
  • Fax: 918-744-3064
Mailing address:
  • Phone: 918-744-3496
  • Fax: 918-744-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number18378
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: