Individual
DR. CLARK JIRO TINGLEAF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10512 N 110TH EAST AVE, STE 200, OWASSO, OK 74055-6636
(918) 376-8926
(918) 377-8936
Mailing address
10512 N 110TH EAST AVE, STE 200, OWASSO, OK 74055-6636
(918) 376-8926
(918) 377-8936
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
23509
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015250B
—
OK
Enumeration date
07/03/2006
Last updated
09/24/2019
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