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Organization

UTICA PLASTIC SURGERY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT GENE KIRK MD (OWNER)
(918) 582-6958
Entity
Organization

Contact information

Practice address
1145 S UTICA AVE, SUITE 1109, TULSA, OK 74104-4000
(918) 582-6958
(918) 582-8155
Mailing address
1145 S UTICA AVE, SUITE 1109, TULSA, OK 74104-4000
(918) 582-6958
(918) 582-8155

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
12982
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
444447183001
BLUECROSS & BLUESHIELD
OK
Enumeration date
04/17/2007
Last updated
08/22/2020
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