Healthcare Provider Details

I. General information

NPI: 1902262421
Provider Name (Legal Business Name): LP DULLYE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S JACKSON AVE SUITE 200
TULSA OK
74127-9015
US

IV. Provider business mailing address

802 S JACKSON AVE SUITE 200
TULSA OK
74127-9015
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-3372
  • Fax: 918-599-9116
Mailing address:
  • Phone: 918-585-3372
  • Fax: 918-599-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: LARRY J DULLYE
Title or Position: PRESIDENT
Credential: DO
Phone: 918-585-3372