Individual
HENRY K UPCHURCH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 ROCKEFELLER DR, MUSKOGEE, OK 74401-5075
(918) 781-9466
Mailing address
LOCKBOX #17, 2424 E. 21ST #100, TULSA, OK 74114-1711
(866) 321-8433
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
2821
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079370A
—
OK
Enumeration date
10/25/2005
Last updated
07/08/2007
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