Healthcare Provider Details

I. General information

NPI: 1184686651
Provider Name (Legal Business Name): ROXON KRIS LEDOUX CST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E 13TH ST SUITE 100
TULSA OK
74104-4419
US

IV. Provider business mailing address

1809 E 13TH ST SUITE 100
TULSA OK
74104-4419
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-6800
  • Fax:
Mailing address:
  • Phone: 918-582-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number89642
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: