Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25262 | OK |
N | 208600000X | Surgeon | 25262 | OK |
Y | 2086X0206X | Surgical Oncologist | 25262 | OK |
NPI | 1316053994 |
---|---|
Provider Name | Dr. Laurie Wolford Flynn |
First Address | Tulsa, OK 74146-6236 |
Second Address | Tulsa, OK 74104-5407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200094530A | (05) | OK |
P00462134 | RAILROAD MEDICARE (01) | OK |