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General NPI Number Information
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NPI Number | 1417154048
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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 | 06/28/2007
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 1919 S WHEELING AVE STE 600 OU PHYSICIANS TULSA SURGICAL SPECIALIST
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City | TULSA
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State | OK
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Zip | 74104-5635
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Country | US
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Telephone | 918-634-7500
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Fax | 918-634-7560
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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 | 74135-2553
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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 | MR. 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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care 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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery 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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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