Provider Demographics
NPI:1982141362
Name:ELDRIDGE, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7477 E 46TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-6305
Mailing Address - Country:US
Mailing Address - Phone:918-384-0002
Mailing Address - Fax:918-338-4000
Practice Address - Street 1:7477 E 46TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-6305
Practice Address - Country:US
Practice Address - Phone:918-384-0002
Practice Address - Fax:918-338-4000
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2763207QA0401X
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine