Healthcare Provider Details

I. General information

NPI: 1912297805
Provider Name (Legal Business Name): SAMUEL CLAYTON KORBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 308
TULSA OK
74136-7802
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-9650
  • Fax: 918-502-9655
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number31892
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: