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General NPI Number Information
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NPI Number | 1861470841
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Entity Type | Individual
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Provider Name | COLIN A MAROUK D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 2950 S ELM PL STE 460
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7863
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Country | US
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Telephone | 918-884-2884
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Fax | 918-499-3175
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE STE 1400
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City | TULSA
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State | OK
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Zip | 74136-3310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3142
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License Number State | OK
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