Provider Demographics
NPI:1316053994
Name:FLYNN, LAURIE WOLFORD (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:WOLFORD
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12697 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6236
Mailing Address - Country:US
Mailing Address - Phone:918-505-9320
Mailing Address - Fax:855-578-9798
Practice Address - Street 1:1819 E 19TH ST FL 5
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5407
Practice Address - Country:US
Practice Address - Phone:918-505-3200
Practice Address - Fax:855-578-9798
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25262208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094530AMedicaid
OKP00462134OtherRAILROAD MEDICARE
OK200094530AMedicaid
OKOKAAA1369Medicare PIN