Provider Demographics
NPI:1982882692
Name:SOUTH TULSA FAMILY PRACITCE INC
Entity Type:Organization
Organization Name:SOUTH TULSA FAMILY PRACITCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KONDOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-461-2441
Mailing Address - Street 1:8136 S MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4309
Mailing Address - Country:US
Mailing Address - Phone:918-461-2441
Mailing Address - Fax:918-461-2469
Practice Address - Street 1:8136 S MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4309
Practice Address - Country:US
Practice Address - Phone:918-461-2441
Practice Address - Fax:918-461-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty