Healthcare Provider Details

I. General information

NPI: 1720467483
Provider Name (Legal Business Name): METRO TULSA FOOT & ANKLE SPECIALIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 S HARVARD AVE
TULSA OK
74135-2227
US

IV. Provider business mailing address

3627 S HARVARD AVE
TULSA OK
74135-2227
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-2902
  • Fax: 918-494-2905
Mailing address:
  • Phone: 918-477-4855
  • Fax: 918-301-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number154
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number154
License Number StateOK

VIII. Authorized Official

Name: MRS. DANA JO JAMISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-494-2902