Healthcare Provider Details

I. General information

NPI: 1649477092
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E. 41ST ST., 3RD FLOOR, STE B OU PHYSICIANS TULSA WOMEN'S HEALTH CARE SPECIALIST
TULSA OK
74135-2527
US

IV. Provider business mailing address

4502 E 41ST ST # 2G08 OU PHYSICIANS TULSA-CLINICAL SERVICES
TULSA OK
74135-2553
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3614
  • Fax: 918-660-3631
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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