Individual
COLONY S FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
717 S HOUSTON AVE FL 4, TULSA, OK 74127-9023
(918) 382-4600
(918) 382-3183
Mailing address
717 S HOUSTON AVE FL 4, TULSA, OK 74127-9023
(918) 382-4600
(918) 382-3183
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3923
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200035440B
—
OK
Enumeration date
09/15/2006
Last updated
02/13/2019
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