MEDICARE: ROBERT DALE MCCULLOUGH II DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1290	OK

General Provider Information

NPI Number	:	1659331486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DALE MCCULLOUGH II DO

Provider Business Mailing Address
First Line	:	5803 E 75TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7255
Country	:	US
Telephone Number	:	918-481-8725
Fax Number	:

Provider Business Practice Location Address
First Line	:	5803 E 75TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7255
Country	:	US
Telephone Number	:	918-481-8725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	03/07/2023

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