Basic Information
| Provider Information | |||||||||
| NPI: | 1366423865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BLAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5657 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741356010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186222500 | ||||||||
| FaxNumber: | 9186222502 | ||||||||
| Practice Location | |||||||||
| Address1: | 5657 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186222500 | ||||||||
| FaxNumber: | 9186222502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4111 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200031970B | 05 | OK | MEDICAID |