MEDICARE: OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician
2	207ND0101X	MOHS-Micrographic Surgery Physician

General Provider Information

NPI Number	:	1104291236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE LLC

Provider Business Mailing Address
First Line	:	12697 E 51ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-6236
Country	:	US
Telephone Number	:	918-307-0215
Fax Number	:	918-250-7669

Provider Business Practice Location Address
First Line	:	800 W BOISE CIR STE 400
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4974
Country	:	US
Telephone Number	:	918-307-0215
Fax Number	:	918-250-7669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARON G. STREET
Credential	:	M.D.
Telephone Number	:	918-505-3200

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	08/11/2025

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