Healthcare Provider Details

I. General information

NPI: 1679287767
Provider Name (Legal Business Name): LESLEY V LANDIS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 E 21ST ST STE 325
TULSA OK
74114-1403
US

IV. Provider business mailing address

2005 E 21ST ST STE 325
TULSA OK
74114-1403
US

V. Phone/Fax

Practice location:
  • Phone: 918-764-8516
  • Fax: 918-764-8514
Mailing address:
  • Phone: 918-764-8516
  • Fax: 918-764-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLEY LANDIS
Title or Position: OWNER
Credential: MD
Phone: 405-650-3452