Provider Demographics
NPI:1821316548
Name:CHILD NEUROLOGY OF TULSA, PC
Entity Type:Organization
Organization Name:CHILD NEUROLOGY OF TULSA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:SIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-493-3300
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-493-3300
Mailing Address - Fax:918-493-3315
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:STE 320
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-493-3300
Practice Address - Fax:918-493-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100213720BMedicaid
OK100213720BMedicaid