Organization
GEORGE BOVASSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE BOVASSO D.O. (OWNER/PHYSICIAN)
(918) 586-3948
Entity
Organization
Contact information
Practice address
1212 E 58TH ST, TULSA, OK 74105-8401
(918) 743-1402
Mailing address
PO BOX 6395, TULSA, OK 74148-0395
(918) 586-3948
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1582
OK
Other
Enumeration date
03/28/2008
Last updated
03/28/2008
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