Provider Demographics
NPI:1952361834
Name:PENDELL, GEORGE MUMFORD III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MUMFORD
Last Name:PENDELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-392-7000
Mailing Address - Fax:918-392-7013
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:STE 270
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-7000
Practice Address - Fax:918-392-7013
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131790AMedicaid
OKOKAAA2109Medicare PIN
OK100131790AMedicaid
OK100131790AMedicaid