Healthcare Provider Details

I. General information

NPI: 1255428991
Provider Name (Legal Business Name): DEANNA SUE STORTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S. PEORIA AVENUE
TULSA OK
74120-3820
US

IV. Provider business mailing address

550 S. PEORIA AVENUE
TULSA OK
74120-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-582-8552
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-582-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14424
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14424
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: