Healthcare Provider Details

I. General information

NPI: 1720151707
Provider Name (Legal Business Name): CONCHITA L WOODRUFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S UTICA AVE 3RD FLOOR
TULSA OK
74104-4214
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-2229
  • Fax: 918-579-2239
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23123
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: