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Organization
OKLAHOMA PHYSICAL MEDICINE AND REHABILITATION, PC
Active
Organization
OKLAHOMA PHYSICAL MEDICINE AND REHABILITATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY G PETTINGELL M.D. (PHYSICIAN)
(918) 252-7952
Entity
Organization
Contact information
Practice address
1621 S EUCALYPTUS AVE, SUITE 204, BROKEN ARROW, OK 74012-5940
(918) 252-7952
Mailing address
10026 S MINGO RD STE A, PMB 234, TULSA, OK 74133-5717
(918) 252-7952
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434452335005
BLUE CROSS BLUE SHIELD
OK
Enumeration date
05/02/2007
Last updated
08/22/2020
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