Healthcare Provider Details

I. General information

NPI: 1932543113
Provider Name (Legal Business Name): LINDSAY K ZUCK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY K JOHNSON

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

IV. Provider business mailing address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-3100
  • Fax: 918-458-3610
Mailing address:
  • Phone: 918-458-3100
  • Fax: 918-458-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6078
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: