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Organization

CENTER FOR PLASTIC SURGERY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK L. MATHERS D.O. (PHYSICIAN)
(918) 749-7177
Entity
Organization

Contact information

Practice address
1844 E 15TH ST, TULSA, OK 74104-4611
(918) 749-7177
(918) 749-7309
Mailing address
1844 E 15TH ST, TULSA, OK 74104-4611
(918) 749-7177
(918) 749-7309

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
2384
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100742880A
OK
01
442629711-001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
12/21/2006
Last updated
07/07/2010
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