Provider Demographics
NPI:1972586782
Name:LEE, LAURA L (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 S DARLINGTON AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6348
Mailing Address - Country:US
Mailing Address - Phone:918-743-8838
Mailing Address - Fax:918-743-9058
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:STE 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-743-8838
Practice Address - Fax:918-743-9058
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK128502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300105717OtherRAILROAD MEDICARE
OK300129664OtherRAILROAD MEDICARE
OK100129390BMedicaid
OK300129664OtherRAILROAD MEDICARE
OK100129390BMedicaid
OK100129390BMedicaid