Healthcare Provider Details

I. General information

NPI: 1689729907
Provider Name (Legal Business Name): TRANSFORMING LIVES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD SECOND FLOOR
EDMOND OK
73013-3023
US

IV. Provider business mailing address

1800 RENAISSANCE BLVD SECOND FLOOR
EDMOND OK
73013-3023
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2475
  • Fax: 405-341-2495
Mailing address:
  • Phone: 405-359-2468
  • Fax: 405-359-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY WALTON
Title or Position: OWNER
Credential: MD
Phone: 405-359-2475