Healthcare Provider Details

I. General information

NPI: 1447168083
Provider Name (Legal Business Name): MATTHEW ROBERT MAGRO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

3405 OAKHILL DR
TULSA OK
74132-2904
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-4400
  • Fax:
Mailing address:
  • Phone: 419-463-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUJ029262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: