Healthcare Provider Details

I. General information

NPI: 1215996335
Provider Name (Legal Business Name): LORRY C KROUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORRY C STAYTON MD

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4722 N 24TH ST SUITE 150
PHOENIX AZ
85016-4800
US

V. Phone/Fax

Practice location:
  • Phone: 405-579-1444
  • Fax:
Mailing address:
  • Phone: 877-737-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21271
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number21271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: