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Individual

GARY FENNEMA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
744 W 9TH ST, TULSA, OK 74127-9020
(918) 599-1000
Mailing address
2622 W 112TH PL S, JENKS, OK 74037-2127
(918) 691-4601

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6402
OK

Other

Enumeration date
03/04/2017
Last updated
12/17/2022
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