Healthcare Provider Details

I. General information

NPI: 1497462501
Provider Name (Legal Business Name): MOLLY ANNE BAYLESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY ANNE BROWNELL

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

4444 E 41ST ST
TULSA OK
74135-2527
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4100
  • Fax:
Mailing address:
  • Phone: 918-619-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50123
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: