Individual
TATE CAMREN VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 582-1980
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 582-1980
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6787
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/28/2018
Last updated
10/20/2021
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