Healthcare Provider Details

I. General information

NPI: 1033103304
Provider Name (Legal Business Name): ETHAN D LINDSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 NW 50TH ST
OKLAHOMA CITY OK
73118-4401
US

IV. Provider business mailing address

1117 NW 50TH ST
OKLAHOMA CITY OK
73118-4401
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-4435
  • Fax: 405-842-2846
Mailing address:
  • Phone: 405-842-4435
  • Fax: 405-842-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16538
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: