Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 23753 | OK |
NPI | 1073584306 |
---|---|
Provider Name | Kelly R Flesner |
First Address | Tulsa, OK 74133-5718 |
Second Address | Tulsa, OK 74104-4243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 22/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200023810A | (05) | OK |
H12205 | (02) | OK |
OK700120 | MEDICARE PTAN (01) | OK |
P00251493 | MEDICARE RAILROAD (01) | OK |
P00613407 | MEDICARE RAILROAD (01) | OK |