Healthcare Provider Details

I. General information

NPI: 1992748917
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 19TH ST SUITE 502 OU PHYSICIANS TULSA DERMATOLOGY CLINIC
TULSA OK
74104-5405
US

IV. Provider business mailing address

4502 E 41ST ST 2GO8 OU PHYSICIANS TULSA - OFFICE CLINICAL SERVICES
TULSA OK
74134-2553
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-6675
  • Fax:
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAIN L MADDY
Title or Position: CEO OU PHYSICIANS
Credential:
Phone: 405-271-3932