Provider Demographics
NPI:1205836244
Name:EMEL, T JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:T
Middle Name:JEFFREY
Last Name:EMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:JEFFREY
Other - Last Name:EMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-494-9341
Mailing Address - Fax:918-494-9355
Practice Address - Street 1:6475 S YALE AVE STE 301
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9355
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12693207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118540AMedicaid