# EASTERN OKLAHOMA EAR, NOSE & THROAT INC

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

## Provider details

- **NPI number:** 1205052149
- **Authorized official:** SUSAN WEATHERLY (CREDENTIALING CLERK)
- **Authorized official phone:** (918) 491-3314

## Contact information

- **Practice address:** 5020 E 68TH ST, TULSA, OK 74136-3307
- **Practice address phone:** (918) 492-3636
- **Practice address fax:** (918) 494-8915
- **Mailing address:** 5020 E 68TH ST, TULSA, OK 74136-3307
- **Mailing address phone:** (918) 492-3636
- **Mailing address fax:** (918) 494-8915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0012X | Sleep Medicine (Otolaryngology) Physician | — | NULL | Yes |
| 207YS0012X | Sleep Medicine (Otolaryngology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 12/09/2010