Provider Demographics
NPI:1700953338
Name:MARKS-SNELLING, JUDY (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:MARKS-SNELLING
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 1:4833 S SHERIDAN RD
Mailing Address - Street 2:416
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5750
Mailing Address - Country:US
Mailing Address - Phone:918-749-3187
Mailing Address - Fax:918-491-9925
Practice Address - Street 1:4833 S SHERIDAN RD
Practice Address - Street 2:416
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5750
Practice Address - Country:US
Practice Address - Phone:918-749-3187
Practice Address - Fax:918-491-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2649207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE71130Medicare UPIN