Healthcare Provider Details

I. General information

NPI: 1275731697
Provider Name (Legal Business Name): EUGENE OTTO DICKENS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E 13TH ST #400
TULSA OK
74104-4419
US

IV. Provider business mailing address

1809 E 13TH ST #400
TULSA OK
74104-4419
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-8200
  • Fax: 918-587-1707
Mailing address:
  • Phone: 918-599-8200
  • Fax: 918-587-1707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21225
License Number StateOK

VIII. Authorized Official

Name: EUGENE DICKENS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 918-599-8200