Provider Demographics
NPI:1710050869
Name:MCINTOSH, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:MCINTOSH
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 1:10109 E 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-286-5000
Mailing Address - Fax:918-249-7514
Practice Address - Street 1:10109 E. 79TH STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-286-5000
Practice Address - Fax:918-249-7514
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046450207VX0201X
OK13117207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4604246OtherAETNA
051523563OtherBCBS AL SVC PROVIDED AL
MS07020061OtherUP MS MCAID NUMBER
AL009902615Medicaid
GA304107Medicaid
58257864831902A001OtherTRICARE WPS
984965OtherBCBS GA
GA00806671BMedicaid
AL009900735Medicaid
060019730OtherBCBS AL SVC PROVIDED GA
AL009900735Medicaid
GA00806671BMedicaid
4604246OtherAETNA
160057350Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MS07020061OtherUP MS MCAID NUMBER