Provider Demographics
NPI:1558395517
Name:MONCADA, FRANZ (MD)
Entity Type:Individual
Prefix:
First Name:FRANZ
Middle Name:
Last Name:MONCADA
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 1:6465 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-4880
Mailing Address - Fax:918-481-4899
Practice Address - Street 1:6465 S YALE AVE STE 408
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7806
Practice Address - Country:US
Practice Address - Phone:918-481-4880
Practice Address - Fax:918-481-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11091261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center