=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669433421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY CLINGAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 10/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1705 E 19TH ST STE 502
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-748-7800
-----------------------------------------------------
Fax | 918-748-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1705 E 19TH ST STE 502
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-748-7800
-----------------------------------------------------
Fax | 918-748-7801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number | 21220
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------