Individual
TIMOTHY BLACKSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4502 E 41ST ST, TULSA, OK 74135-2536
(918) 579-2367
Mailing address
4308 W KENT ST, BROKEN ARROW, OK 74012-9419
(918) 644-9799
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/18/2023
Last updated
04/02/2025
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