Healthcare Provider Details

I. General information

NPI: 1114923794
Provider Name (Legal Business Name): LAURIE ANN DUCKETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E 13TH ST STE 400
TULSA OK
74104-4431
US

IV. Provider business mailing address

1809 E 13TH ST STE 400
TULSA OK
74104-4431
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-8200
  • Fax: 918-579-2559
Mailing address:
  • Phone: 918-599-8200
  • Fax: 918-579-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2860
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: