Provider Demographics
NPI:1619058153
Name:PULMONARY MEDICINE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:PULMONARY MEDICINE OF OKLAHOMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NADER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-298-7856
Mailing Address - Street 1:8177 S HARVARD AVE
Mailing Address - Street 2:#735
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1612
Mailing Address - Country:US
Mailing Address - Phone:918-298-7856
Mailing Address - Fax:918-299-3207
Practice Address - Street 1:10109 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4564
Practice Address - Country:US
Practice Address - Phone:918-298-7856
Practice Address - Fax:918-299-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2441207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD38567Medicare UPIN
OK2526902580Medicare ID - Type Unspecified