Healthcare Provider Details

I. General information

NPI: 1487611570
Provider Name (Legal Business Name): RICK LYNN VISOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD SUITE 115
OKLAHOMA CITY OK
73120
US

IV. Provider business mailing address

4140 W MEMORIAL RD SUITE 115
OKLAHOMA CITY OK
73120
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-6475
  • Fax: 405-755-8370
Mailing address:
  • Phone: 405-755-6475
  • Fax: 405-755-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20577
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: