MEDICARE: DIANE PENSE M.D.

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	19802	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710965785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE PENSE M.D.

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	SUITE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3347
Country	:	US
Telephone Number	:	918-488-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 S 79TH EAST AVE
Second Line	:	SUITE 300
City	:	TULSA
State	:	OK
Zip	:	74145-1316
Country	:	US
Telephone Number	:	918-728-6800
Fax Number	:	918-728-6801

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	12/28/2011

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Directions to “ DIANE PENSE M.D.” Practice Location

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