NPIMap

Organization Active NPI

South Tulsa Pediatrics PLLJ

  • Pediatrics Physician
  • Tulsa, OK
National Provider Identifier
1215920293
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2732 Issued in OK
Legal business name
SOUTH TULSA PEDIATRICS PLLJ
Practice address
7512 E 91St St
Tulsa, OK 74133-6050
Phone
(918) 728-2000
Fax
(917) 728-2000
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn A Mayberry, D.O.NPI 1558351221
Title
Owner/Physician
Phone
(918) 728-2888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 2732 OK Primary

Addresses

Primary practice location

7512 E 91St St
Tulsa, OK 74133-6050

Mailing address

7512 E 91St St
Tulsa, OK 74133-6050
Phone (918) 728-2000

National Provider Directory

National Provider Directory

Locations

7512 E 91st St
Tulsa, OK 74133
Phone (918) 728-2000

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215920293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7512 E 91ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336050",
            "telephone_number": "918-728-2000",
            "fax_number": "917-728-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7512 E 91ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336050",
            "telephone_number": "918-728-2000",
            "fax_number": "917-728-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TULSA PEDIATRICS PLLJ",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAYBERRY",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "918-728-2888",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "2732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.