Healthcare Provider Details

I. General information

NPI: 1740453976
Provider Name (Legal Business Name): LISA D TAYLOR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 MEMORIAL CIR SUITE B
OKLAHOMA CITY OK
73142-5000
US

IV. Provider business mailing address

4514 W MEMORIAL CIR SUITE B
OKLAHOMA CITY OK
73142
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-1321
  • Fax:
Mailing address:
  • Phone: 405-751-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number17865
License Number StateOK

VIII. Authorized Official

Name: MRS. HELEN HART TAYLOR
Title or Position: CORPORATION SECRETARY
Credential:
Phone: 405-751-1321