Individual
JOHN CONVILLE FUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
591 E 36TH ST N, TULSA, OK 74106-1812
(918) 619-4400
(918) 619-8776
Mailing address
PO BOX 268838, OKLAHOMA CITY, OK 73126-8838
(918) 660-3632
(918) 660-3631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19139
OK
207RG0100X
Gastroenterology Physician
Primary
19139
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003710B
—
OK
Enumeration date
01/26/2006
Last updated
05/13/2013
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