Provider Demographics
NPI:1922077536
Name:VASQUEZ-HARMON, ETHEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:
Last Name:VASQUEZ-HARMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N. HARVARD
Mailing Address - Street 2:STE. E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115
Mailing Address - Country:US
Mailing Address - Phone:918-832-6049
Mailing Address - Fax:918-832-6055
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7600
Practice Address - Fax:918-293-3109
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100256910AMedicaid
OKG52032Medicare UPIN