Provider Demographics
NPI:1275562076
Name:AREVALOS, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:AREVALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 S DOUGLAS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1014
Mailing Address - Country:US
Mailing Address - Phone:405-737-7000
Mailing Address - Fax:405-272-2898
Practice Address - Street 1:3400 S DOUGLAS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1014
Practice Address - Country:US
Practice Address - Phone:405-737-7000
Practice Address - Fax:405-272-2898
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F46207R00000X
OK15416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202233201Medicaid
OK100135630AMedicaid
MO202233201Medicaid
OK245730301Medicare PIN
OK100135630AMedicaid