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

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

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)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193400000X SINGLE SPECIALTY GROUP
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

Other providers in Tulsa, OK

All providers in Tulsa, OK · Pediatrics Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.