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General NPI Number Information
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NPI Number | 1184982423
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Entity Type | Individual
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Provider Name | LEAH UPTON D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 11511 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74146-1908
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Country | US
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Telephone | 918-400-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 715 W MAIN ST SUITE S
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City | JENKS
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State | OK
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Zip | 74037-3553
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Country | US
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Telephone | 918-299-9447
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Fax | 918-299-5325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5453
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License Number State | OK
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