Healthcare Provider Details

I. General information

NPI: 1962030015
Provider Name (Legal Business Name): KENNETH GARLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9907
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE 390
TULSA OK
74133-7549
US

V. Phone/Fax

Practice location:
  • Phone: 580-583-9307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7349
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: