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General NPI Number Information
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NPI Number | 1518900505
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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 | 06/14/2006
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 4444 E 41ST STREET 3RD FLOOR STE B SCHUSTERMAN CENTER CLINIC
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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 | 918-619-4101
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Fax | 918-619-4110
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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 | 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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) 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 | 207RG0100X
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Taxonomy Name | Gastroenterology 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 | 207RR0500X
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Taxonomy Name | Rheumatology 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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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