Individual
DR. JUSTIN THOMAS ATHERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 744-3633
Mailing address
1725 E 19TH ST, SUITE 800, TULSA, OK 74104-5472
(918) 301-2505
(918) 744-3633
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19797
OK
2086S0127X
Trauma Surgery Physician
19797
OK
2086S0129X
Vascular Surgery Physician
19797
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020045078
RAILROAD MEDICARE
OK
05
—
100131760A
—
OK
Enumeration date
06/29/2006
Last updated
03/09/2010
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