Healthcare Provider Details

I. General information

NPI: 1265876791
Provider Name (Legal Business Name): MATTHEW THOMAS MCCLURG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6839 S CANTON AVE
TULSA OK
74136-3402
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-0612
  • Fax:
Mailing address:
  • Phone: 918-494-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6213
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: