Basic Information
| Provider Information | |||||||||
| NPI: | 1609832898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PO | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | D. | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 717 S HOUSTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741279005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185864500 | ||||||||
| FaxNumber: | 9185864528 | ||||||||
| Practice Location | |||||||||
| Address1: | 717 S HOUSTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741279005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185864500 | ||||||||
| FaxNumber: | 9185864528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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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 | 207V00000X | 26309 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | OK400783 | 01 | OK | MEDICARE | OTHER | 200201500A | 05 | OK | MEDICAID |