Provider Demographics
NPI:1497746903
Name:MONROE, CALVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:P
Last Name:MONROE
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 1:1216 EAST APACHE STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-3938
Mailing Address - Country:US
Mailing Address - Phone:918-794-5800
Mailing Address - Fax:918-794-7775
Practice Address - Street 1:1500 E DOWNING ST STE 208
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3234
Practice Address - Country:US
Practice Address - Phone:918-456-2496
Practice Address - Fax:918-456-7108
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-1832OtherMEDICARE
OK200067100AMedicaid
OK100768880IMedicaid
OK37-1803OtherMEDICARE
OK100768880JMedicaid
OK100768880FMedicaid
OK37-1834OtherMEDICARE
OK100768880FMedicaid
OK37-1834OtherMEDICARE
OK200067100AMedicaid
OK200067100AMedicaid