Healthcare Provider Details

I. General information

NPI: 1750400230
Provider Name (Legal Business Name): MIDTOWN DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 E. 21ST STREET SUITE 340
TULSA OK
74114
US

IV. Provider business mailing address

2424 E. 21ST STREET SUITE 340
TULSA OK
74114
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-3100
  • Fax: 918-728-3376
Mailing address:
  • Phone: 918-728-3100
  • Fax: 918-728-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18895
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: GRETA TERHUNE
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-743-4046