Provider Demographics
NPI:1801823752
Name:SILAS, GEETA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETA
Middle Name:ROSE
Last Name:SILAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2617 S ELM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7850
Mailing Address - Country:US
Mailing Address - Phone:918-455-8545
Mailing Address - Fax:918-455-2521
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-382-1285
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK15200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100228140AMedicaid
OK100228140AMedicaid
E69588Medicare UPIN