MEDICARE: DR. PHYLLIS WHITE LAUINGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	10119	OK

General Provider Information

NPI Number	:	1730103185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHYLLIS WHITE LAUINGER M.D.

Provider Business Mailing Address
First Line	:	1923 E 47TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-4916
Country	:	US
Telephone Number	:	918-749-2600
Fax Number	:	918-749-6106

Provider Business Practice Location Address
First Line	:	2448 E ADMIRAL BLVD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74110-5323
Country	:	US
Telephone Number	:	918-583-7233
Fax Number	:	918-583-7205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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