Organization
EASTERN OKLAHOMA EAR, NOSE & THROAT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN WEATHERLY (CREDENTIALING CLERK)
(918) 491-3314
Entity
Organization
Contact information
Practice address
5020 E 68TH ST, TULSA, OK 74136-3307
(918) 492-3636
(918) 494-8915
Mailing address
5020 E 68TH ST, TULSA, OK 74136-3307
(918) 492-3636
(918) 494-8915
Taxonomy
Speciality
Code
Description
License number
State
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100805560B
—
OK
Enumeration date
04/18/2007
Last updated
12/09/2010
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