Healthcare Provider Details

I. General information

NPI: 1538356530
Provider Name (Legal Business Name): TULSA FOOT & ANKLE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 E 47TH PL STE 102
TULSA OK
74135-2911
US

IV. Provider business mailing address

3315 E 47TH PL STE 102
TULSA OK
74135-2911
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-4484
  • Fax: 918-749-2350
Mailing address:
  • Phone: 918-749-4484
  • Fax: 918-749-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number188
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT HAYES LEE
Title or Position: OWNER
Credential: D.P.M.
Phone: 918-749-4484