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