Healthcare Provider Details

I. General information

NPI: 1255434783
Provider Name (Legal Business Name): LEO LU MD FCAP FIAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE SUITE 300
OKLAHOMA CITY OK
73103-2400
US

IV. Provider business mailing address

1211 N SHARTEL AVE SUITE 300
OKLAHOMA CITY OK
73103-2400
US

V. Phone/Fax

Practice location:
  • Phone: 405-235-8008
  • Fax: 405-239-2403
Mailing address:
  • Phone: 405-235-8008
  • Fax: 405-239-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number0101238346
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME65063
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number21011
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number040770
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number200501805
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number40308
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number057750
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number0101238346
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME65063
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number21011
License Number StateOK
# 11
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number040770
License Number StateCT
# 12
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number200501805
License Number StateNC
# 13
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number40308
License Number StateTN
# 14
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number057750
License Number StateGA
# 15
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number12064
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: