Avalon Park Pediatrics
Organization Active NPI Pediatrics Physician · Tulsa, OK
NPI 1720204761 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720204761
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 20582 (OK)
- Legal business name
- AVALON PARK PEDIATRICS
- Practice address
- 6528 E 101St St
Suite D-1, PMB 419
Tulsa, OK 74133-6724 - Phone
- (918) 398-7170
- Fax
- (918) 398-7199
- NPI assigned
- Apr 18, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. David Brian Raley, MD
- Title
- Owner
- Phone
- (918) 398-7170
Practitioners 1
National Provider Directory
Locations
6528 E 101st St
Ste D1
Tulsa, OK 74133
Phone (918) 398-7170
7779 E 106th St
Tulsa, OK 74133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 20582 | OK | Yes |
Addresses
Primary practice location
6528 E 101St St
Suite D-1, PMB 419
Tulsa, OK 74133-6724
Mailing address
7779 East 106TH Street
Tulsa, OK 74133-6844
Phone (918) 398-7170
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All providers in Tulsa, OK · Pediatrics Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.