Healthcare Provider Details

I. General information

NPI: 1316053994
Provider Name (Legal Business Name): LAURIE WOLFORD FLYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 E 19TH ST FL 5
TULSA OK
74104-5407
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax: 855-578-9798
Mailing address:
  • Phone: 918-505-9320
  • Fax: 855-578-9798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25262
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25262
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: