Individual
AUSTIN VACLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(918) 561-8257
Mailing address
1111 W 17TH ST, TULSA, OK 74107-1886
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
SL2467
NV
Other
Enumeration date
09/25/2023
Last updated
11/06/2025
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