Provider Demographics
NPI:1992814909
Name:CALVERT, JOSHUA T (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:T
Last Name:CALVERT
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 1:1705 E 19TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5410
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:918-874-8753
Practice Address - Street 1:1705 E 19TH ST STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5410
Practice Address - Country:US
Practice Address - Phone:918-748-7585
Practice Address - Fax:918-874-8753
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042970208M00000X
OK25602208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200109790AMedicaid
P00117240OtherRAILROAD MEDICARE
P00117240OtherRAILROAD MEDICARE
OK200109790AMedicaid