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General NPI Number Information
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NPI Number | 1477752624
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Entity Type | Organization
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Legal Business Name | LARRY J LEYSER, MD
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 6151 S YALE AVE SUITE 303
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City | TULSA
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State | OK
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Zip | 74136-1907
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Country | US
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Telephone | 918-502-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 6151 S YALE AVE SUITE 303
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City | TULSA
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State | OK
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Zip | 74136-1907
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Country | US
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Telephone | 918-502-2300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARRY JAMES LEYSER
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Credential | MD
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Telephone | 918-502-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 24948
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License Number State | OK
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