Provider Demographics
NPI:1154382711
Name:SURBECK, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SURBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 S 109TH EAST AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-236-4567
Mailing Address - Fax:918-236-4578
Practice Address - Street 1:4812 S 109TH EAST AVE
Practice Address - Street 2:STE. 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-236-4567
Practice Address - Fax:918-236-4578
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16971207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100136560AMedicaid
OK246722702Medicare PIN
OKF58221Medicare UPIN