# EAST TULSA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114336534
- **Authorized official:** JEFF A BARENTINE PA (PARTNER)
- **Authorized official phone:** (918) 437-6830

## Contact information

- **Practice address:** 11445 E 20TH ST, TULSA, OK 74128-6421
- **Practice address phone:** (918) 437-6830
- **Practice address fax:** (918) 437-6171
- **Mailing address:** 11445 E 20TH ST, TULSA, OK 74128-6421
- **Mailing address phone:** (918) 437-6830
- **Mailing address fax:** (918) 437-6171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1567 | OK | Yes |

## Other

- **Enumeration date:** 08/11/2014
- **Last updated:** 08/11/2014