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General NPI Number Information
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NPI Number | 1689729907
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Entity Type | Organization
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Legal Business Name | TRANSFORMING LIVES PLLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 1800 RENAISSANCE BLVD SECOND FLOOR
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City | EDMOND
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State | OK
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Zip | 73013-3023
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Country | US
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Telephone | 405-359-2475
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Fax | 405-341-2495
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Provider Business Mailing Address
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Address Line | 1800 RENAISSANCE BLVD SECOND FLOOR
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City | EDMOND
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State | OK
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Zip | 73013-3023
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Country | US
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Telephone | 405-359-2468
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Fax | 405-359-2493
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY WALTON
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Credential | MD
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Telephone | 405-359-2475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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