Healthcare Provider Details

I. General information

NPI: 1093083727
Provider Name (Legal Business Name): ONCOLOGY DEVELOPMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 E 81ST ST SUITE 110
TULSA OK
74137-4200
US

IV. Provider business mailing address

2408 E 81ST ST SUITE 110
TULSA OK
74137-4200
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-1791
  • Fax: 918-587-1795
Mailing address:
  • Phone: 918-587-1791
  • Fax: 918-587-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: JAMES HENRY BRUER
Title or Position: PRESIDENT
Credential:
Phone: 918-760-5678