Provider Demographics
NPI:1780483735
Name:MARICLE, EVAN BROOKE
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:BROOKE
Last Name:MARICLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W BOWEN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-8528
Mailing Address - Country:US
Mailing Address - Phone:918-798-8420
Mailing Address - Fax:
Practice Address - Street 1:1729 S BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4807
Practice Address - Country:US
Practice Address - Phone:918-599-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist