Healthcare Provider Details

I. General information

NPI: 1104291236
Provider Name (Legal Business Name): OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BOISE CIR STE 400
BROKEN ARROW OK
74012-4974
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-0215
  • Fax: 918-250-7669
Mailing address:
  • Phone: 918-307-0215
  • Fax: 918-250-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARON G. STREET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-505-3200