Provider Demographics
NPI:1285646018
Name:OBSTETRICAL & GYNECOLOGICAL ASSOC OF TULSA
Entity type:Organization
Organization Name:OBSTETRICAL & GYNECOLOGICAL ASSOC OF TULSA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-742-8847
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-742-8847
Mailing Address - Fax:918-877-1285
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5405
Practice Address - Country:US
Practice Address - Phone:918-742-8847
Practice Address - Fax:918-877-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty