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AVALON PARK PEDIATRICS NPI 1720204761


NPI Information

NPI: 1720204761
Provider Name: AVALON PARK PEDIATRICS
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 37D1088243

Address:
6528 E 101ST ST
SUITE D-1, PMB 419
TULSA, OK
ZIP 74133
Phone: (918) 398-7170
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AVALON PARK PEDIATRICS is a pediatrics in Tulsa, OK. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. AVALON PARK PEDIATRICS NPI is 1720204761. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6528 E 101ST ST
SUITE D-1, PMB 419
TULSA, OK
ZIP 74133-724
Phone: (918) 398-7170
Fax: (918) 398-7199

The provider's authorized official is David Brian Raley .
The authorized official title is Owner and has the following contact phone number (918) 398-7170.

The CLIA number assigned to this NPI record is 37D1088243 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics20582OKLAHOMAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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