Healthcare Provider Details

I. General information

NPI: 1265616064
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST 1ST FLOOR STE B OU PHYSICIANS TULSA PEDIATRIC DIABETES CENTER & HA
TULSA OK
74135-2527
US

IV. Provider business mailing address

4502 E 41ST ST 2G08 OU PHYSICIANS TULSA-CLINICAL SERVICES
TULSA OK
74135-2527
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3632
  • Fax: 918-660-3631
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN L MADDY
Title or Position: CEO OU PHYSICIANS
Credential:
Phone: 405-271-3932