Individual
DR. GREGORY PAUL DISALVATORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10502 N 110TH EAST AVE, OWASSO, OK 74055-6655
(918) 376-8190
(918) 376-8479
Mailing address
1145 S. UTICA AVE., STE. 110, TULSA, OK 74104-4013
(918) 579-3825
(918) 579-1262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3457
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209670A
—
OK
01
—
500522075
MEDICARE GROUP PIN
OK
Enumeration date
10/10/2005
Last updated
05/05/2014
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