Basic Information
| Provider Information | |||||||||
| NPI: | 1720479371 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSEPH D PARKHURST MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2349 N THOMPKINS AVE | ||||||||
| Address2: | |||||||||
| City: | BETHANY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730085307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054956134 | ||||||||
| FaxNumber: | 4057878466 | ||||||||
| Practice Location | |||||||||
| Address1: | 9220 S PENNSYLVANIA AVE STE B | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731596909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056921331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | PARKHURST | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4054956134 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 11526 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 11526 | 01 | OK | STATE LICENSE | OTHER | 200588080B | 05 | OK | MEDICAID |