Provider Demographics
NPI:1881670032
Name:DAVID B MINOR MD PC
Entity Type:Organization
Organization Name:DAVID B MINOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-712-8888
Mailing Address - Street 1:1516 S YORKTOWN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4918
Mailing Address - Country:US
Mailing Address - Phone:918-712-8888
Mailing Address - Fax:918-712-8892
Practice Address - Street 1:1516 S YORKTOWN PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4918
Practice Address - Country:US
Practice Address - Phone:918-712-8888
Practice Address - Fax:918-712-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14933207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty