Organization

Harvard Family Physicians P C

Legal Business Name

Harvard Family Physicians P C

NPI Number

1306891288

NPI Type

Organization

Enumeration Date

05/23/2006

Specialties

(Taxonomies)

Code

111N00000X
207Q00000X
207V00000X
208000000X

Primary Taxonomy

No
No
No
No

Licenses

State

Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma

License Number

2623
26464
22222
21221
11366
16314
3713
24064
4733

Contact
Information

Purpose

Mailing
Location

Address

7912 E 31ST CT
7912 E 31ST CT

City

Tulsa
Tulsa

State

OK
OK

Postal Code

74145-1315
74145-1315

Country

US
US

Telephone Number

(918) 743-8200
(918) 743-8200

Authorized Official

Name

Dr. Kenneth Muckala

Title or Position

CEO/PRESIDENT

Telephone Number

(918) 743-8200

Identifiers

Identifier

100740300A

Identifier State

OK

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 06/07/2018

Provider Address