Healthcare Provider Details

I. General information

NPI: 1649657263
Provider Name (Legal Business Name): LINDSEY B STULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STANTON L YOUNG BLVD # 1464
OKLAHOMA CITY OK
73104-5018
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD AAT 1464
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5504
  • Fax:
Mailing address:
  • Phone: 405-323-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number54139
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number35965
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: