Healthcare Provider Details

I. General information

NPI: 1942614888
Provider Name (Legal Business Name): LAURA RUTH LUICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND AVE STE 600
OKLAHOMA CITY OK
73112-2090
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9940
  • Fax: 405-713-9941
Mailing address:
  • Phone: 405-713-9940
  • Fax: 405-713-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30719
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: