Healthcare Provider Details

I. General information

NPI: 1710516067
Provider Name (Legal Business Name): KEVIN WARREN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S 101ST EAST AVE
TULSA OK
74133-5716
US

IV. Provider business mailing address

110 W 7TH ST STE 2520
TULSA OK
74119-1104
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-4000
  • Fax:
Mailing address:
  • Phone: 918-579-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberOS22545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: