Boomer, Walter Mark
Boomer, Walter Mark is an individual health care provider with primary practice located at 2832 E 101St St , Tulsa OK 74137-5601. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Boomer, Walter Mark can be contacted via phone (918) 771-4455.Contact Information
Primary practice address
2832 E 101St St
Tulsa OK 74137-5601
Phone: (918) 771-4455
Fax: (918) 771-4447
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 17300 | Oklahoma |
Profile Details
| NPI number | 1578598074 |
|---|---|
| LBN Legal business name | Boomer, Walter Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Oct 28th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578598074 | NPPES |
| Oklahoma | MEDICAID | 100090560A |
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