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General NPI Number Information
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NPI Number | 1902262421
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Entity Type | Organization
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Legal Business Name | LP DULLYE MANAGEMENT, INC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 802 S JACKSON AVE SUITE 200
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City | TULSA
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State | OK
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Zip | 74127-9015
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Country | US
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Telephone | 918-585-3372
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Fax | 918-599-9116
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Provider Business Mailing Address
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Address Line | 802 S JACKSON AVE SUITE 200
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City | TULSA
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State | OK
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Zip | 74127-9015
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Country | US
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Telephone | 918-585-3372
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Fax | 918-599-9116
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY J DULLYE
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Credential | DO
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Telephone | 918-585-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | OK
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