Individual
SOPUKRO W TIENABESO
Inactive
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 E CLARK BASS BLVD, MCALESTER, OK 74501-4209
(918) 426-1800
Mailing address
1316 NW 170TH ST, EDMOND, OK 73003-7410
(405) 285-0796
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24308
OK
Other
Enumeration date
07/05/2006
Last updated
04/29/2026
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