Provider Demographics
NPI:1467992230
Name:SOUTH TULSA ONCOLOGY PROFESSIONALS CANCER ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH TULSA ONCOLOGY PROFESSIONALS CANCER ASSOCIATES
Other - Org Name:STOP CANCER ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RADIATION ONCOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:918-240-9496
Mailing Address - Street 1:13217 S 65TH EAST PL
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3846
Mailing Address - Country:US
Mailing Address - Phone:918-240-9496
Mailing Address - Fax:
Practice Address - Street 1:13217 S 65TH EAST PL
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3846
Practice Address - Country:US
Practice Address - Phone:918-240-9496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK271002085R0001X
2085R0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty