Provider Demographics
NPI:1497039044
Name:UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN FOR GME
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUBIALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-2265
Mailing Address - Street 1:940 STANTON L YOUNG BLVD
Mailing Address - Street 2:BMSB 357
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5020
Mailing Address - Country:US
Mailing Address - Phone:405-271-2265
Mailing Address - Fax:405-271-3032
Practice Address - Street 1:940 STANTON L YOUNG BLVD
Practice Address - Street 2:BMSB 357
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5020
Practice Address - Country:US
Practice Address - Phone:405-271-2265
Practice Address - Fax:405-271-3032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA, BOARD OF REGENTS OF THE OU HEALTH SCIENCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207L00000X, 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 208000000X, 2085R0202X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty