Individual
DOUGLAS JOHN IVINS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 S ST LOUIS AVE, TULSA, OK 74120
(918) 619-4600
(918) 619-4601
Mailing address
PO BOX 268838, OKLAHOMA CITY, OK 73126-8838
(918) 660-3632
(918) 660-3631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23164
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20001760C
—
OK
Enumeration date
02/03/2006
Last updated
07/08/2007
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