Healthcare Provider Details

I. General information

NPI: 1699246645
Provider Name (Legal Business Name): ADVANCED PAIN OF TULSA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 S MINGO RD
TULSA OK
74133-5710
US

IV. Provider business mailing address

6528 E 101ST ST STE D1414
TULSA OK
74133-6724
US

V. Phone/Fax

Practice location:
  • Phone: 918-901-9702
  • Fax:
Mailing address:
  • Phone: 918-901-9701
  • Fax: 918-901-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAM DUY NGUYEN
Title or Position: OWNER
Credential:
Phone: 918-901-9701