Healthcare Provider Details

I. General information

NPI: 1235321472
Provider Name (Legal Business Name): DAVID B MOKHTEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

IV. Provider business mailing address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-1400
  • Fax: 918-392-1488
Mailing address:
  • Phone: 918-392-1400
  • Fax: 918-392-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number2007013978
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD60016648
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number28846
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: