Provider Demographics
NPI:1649565821
Name:KEPHART, JOHN H (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KEPHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0930
Mailing Address - Country:US
Mailing Address - Phone:918-934-8347
Mailing Address - Fax:918-743-8552
Practice Address - Street 1:5801 E. 41ST STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5631
Practice Address - Country:US
Practice Address - Phone:918-934-8347
Practice Address - Fax:918-743-8552
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
PAOT014362207Q00000X
OK57612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES0000Medicare UPIN