MEDICARE: ROXON KRIS LEDOUX CST

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	246ZS0410X	Surgical Technologist	89642	OK

General Provider Information

NPI Number	:	1184686651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXON KRIS LEDOUX CST

Provider Business Mailing Address
First Line	:	1809 E 13TH ST
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74104-4419
Country	:	US
Telephone Number	:	918-582-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 E 13TH ST
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74104-4419
Country	:	US
Telephone Number	:	918-582-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/08/2007

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Directions to “ ROXON KRIS LEDOUX CST” Practice Location

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