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General NPI Number Information
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NPI Number | 1336223817
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Entity Type | Organization
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Legal Business Name | LONE STAR UROLOGY CONSULTANTS PC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 1323 N 16TH AVE
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City | DURANT
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State | OK
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Zip | 74701-2134
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Country | US
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Telephone | 580-924-8884
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Fax | 580-924-8911
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Provider Business Mailing Address
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Address Line | PO BOX 456
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City | DURANT
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State | OK
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Zip | 74702-0456
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Country | US
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Telephone | 580-924-8884
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Fax | 580-924-8911
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NANCY ORTLIP
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Credential |
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Telephone | 580-924-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 20400
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License Number State | OK
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