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Individual

ERICH H MUCKALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
4500 S GARNETT RD, STE 300, TULSA, OK 74146-5229
(918) 728-6194
(918) 664-0267
Mailing address
4500 S GARNETT RD, STE 300, TULSA, OK 74146-5229
(918) 728-6194
(918) 664-0267

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5023
OK
2085R0202X
Diagnostic Radiology Physician
58.002032
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5023
STATE MEDICAL LISCENSE
OK
01
58.002032
TRAINING LICENSE
OH
Enumeration date
05/29/2007
Last updated
04/03/2012
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