Provider Demographics
NPI:1720479371
Name:JOSEPH D PARKHURST MD PC
Entity type:Organization
Organization Name:JOSEPH D PARKHURST MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-495-6134
Mailing Address - Street 1:2349 N THOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5307
Mailing Address - Country:US
Mailing Address - Phone:405-495-6134
Mailing Address - Fax:405-787-8466
Practice Address - Street 1:9220 S PENNSYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6909
Practice Address - Country:US
Practice Address - Phone:405-692-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11526208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11526OtherSTATE LICENSE
OK200588080BMedicaid