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General NPI Number Information
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NPI Number | 1184808974
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Entity Type | Organization
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Legal Business Name | BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 6465 S. YALE, STE 304 OU PHYSICIANS TULSA PEDIATRIC SPECIALIST
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-619-4323
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Fax | 918-619-4322
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Provider Business Mailing Address
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Address Line | 4502 E. 41ST ST, 2G08 OU PHYSICIANS TULSA-CLINICAL SERVICES
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City | TULSA
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State | OK
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Zip | 74135-2527
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Country | US
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Telephone | 918-660-3632
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Fax | 918-660-3631
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Authorized Official
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Title or Position | CEO OU PHYSICIANS
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Name | BRIAN L MADDY
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Credential |
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Telephone | 405-271-3932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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