Healthcare Provider Details

I. General information

NPI: 1760725865
Provider Name (Legal Business Name): NICHOLAS ALEXANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 SOUTHWEST BLVD. OSU HEALTH CARE CENTER
TULSA OK
74107
US

IV. Provider business mailing address

366 E 450 N
SPRINGVILLE UT
84663-1582
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5920
  • Fax:
Mailing address:
  • Phone: 801-592-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: