Individual
DR. DOMINIC M PEDULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 NW 56TH ST, SUITE 200, OKLAHOMA CITY, OK 73112-4538
(405) 947-2228
(405) 947-2307
Mailing address
3300 NW 56TH ST, SUITE 200, OKLAHOMA CITY, OK 73112-4538
(405) 947-2228
(405) 947-2307
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17642
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100012360A
—
OK
01
—
110093997
RR MEDICARE
—
Enumeration date
03/24/2006
Last updated
11/18/2014
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