1891781779 NPI number — GEORGE W MONKS MD

Table of content: GEORGE W MONKS MD (NPI 1891781779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891781779 NPI number — GEORGE W MONKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONKS
Provider First Name:
GEORGE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891781779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74152-0588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-749-2261
Provider Business Mailing Address Fax Number:
918-749-8712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74114-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-749-2261
Provider Business Practice Location Address Fax Number:
918-749-8712
Provider Enumeration Date:
09/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  21737 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7229428 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21737 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00011177 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".