Provider Demographics
NPI:1245334887
Name:ALFREY, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ALFREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26303
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0303
Mailing Address - Country:US
Mailing Address - Phone:405-947-8586
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:802 S JACKSON AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9015
Practice Address - Country:US
Practice Address - Phone:918-582-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19892207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36486Medicare UPIN
OK44745373Medicare ID - Type UnspecifiedNON INDEPENT LAB PROF CHG