Healthcare Provider Details

I. General information

NPI: 1245280312
Provider Name (Legal Business Name): JAMES LAWRENCE FLECKENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11436 S LOUISVILLE PL
TULSA OK
74137-1647
US

IV. Provider business mailing address

11436 S LOUISVILLE PL
TULSA OK
74137-1647
US

V. Phone/Fax

Practice location:
  • Phone: 918-523-7226
  • Fax: 918-518-5136
Mailing address:
  • Phone: 918-523-7226
  • Fax: 918-518-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number23288
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23288
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: