=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487749891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WARREN L. POAG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 E 13TH ST STE 402
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-579-3855
-----------------------------------------------------
Fax | 918-550-6565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1145 S UTICA AVE STE 110
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-579-2981
-----------------------------------------------------
Fax | 918-579-1262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 44239
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------