Healthcare Provider Details

I. General information

NPI: 1871539742
Provider Name (Legal Business Name): EDWIN CURTIS YEARY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5638
US

IV. Provider business mailing address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5638
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7676
  • Fax: 918-293-3130
Mailing address:
  • Phone: 918-748-7676
  • Fax: 918-293-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12655
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number12655
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: