Provider Demographics
NPI:1255560488
Name:COBURN, MATTHEW ZACHARY (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ZACHARY
Last Name:COBURN
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 1:1705 E 19TH ST STE 502
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5416
Mailing Address - Country:US
Mailing Address - Phone:918-748-7800
Mailing Address - Fax:918-403-6349
Practice Address - Street 1:1705 E 19TH ST STE 502
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5416
Practice Address - Country:US
Practice Address - Phone:918-748-7800
Practice Address - Fax:918-403-6349
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27273208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery