Individual
DIANE PENTECOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1611 S UTICA AVE, STE 217, TULSA, OK 74104-4909
(918) 744-3664
(918) 748-7688
Mailing address
1611 S UTICA AVE, STE 217, TULSA, OK 74104-4909
(918) 744-3664
(918) 748-7688
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
16158
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100118480A
—
OK
01
—
P00335038
RR MEDICARE
OK
Enumeration date
04/04/2006
Last updated
05/28/2015
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