Provider Demographics
NPI:1295848422
Name:MAGUIRE, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MAGUIRE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-494-4460
Practice Address - Fax:918-494-4442
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-06-05
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Provider Licenses
StateLicense IDTaxonomies
KS04-23154207X00000X
OK15807207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27644Medicare UPIN