Basic Information
| Provider Information | |||||||||
| NPI: | 1255790333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK D. OLBERT M.D., PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 268821 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731268821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056520981 | ||||||||
| FaxNumber: | 9037975854 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 E I 240 SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731352607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056286000 | ||||||||
| FaxNumber: | 4056286916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2016 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | OLBERT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4056963687 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.