Provider Demographics
NPI:1851712459
Name:MCRALIP, BENNETT WILLIAM JR
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:WILLIAM
Last Name:MCRALIP
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 S. BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119
Mailing Address - Country:US
Mailing Address - Phone:918-936-1185
Mailing Address - Fax:
Practice Address - Street 1:1729 S. BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119
Practice Address - Country:US
Practice Address - Phone:918-936-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program