# LESA J BETHEL MULLIGAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669506507
- **Authorized official:** MS. ANN M HOPKINS (INSURANCE COORDINATOR)
- **Authorized official phone:** (405) 364-0643

## Contact information

- **Practice address:** 1139 36TH AVE NW STE 100, NORMAN, OK 73072-4104
- **Practice address phone:** (405) 364-0643
- **Practice address fax:** (405) 364-0502
- **Mailing address:** 1139 36TH AVE NW STE 100, NORMAN, OK 73072-4104
- **Mailing address phone:** (405) 364-0643
- **Mailing address fax:** (405) 364-0502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 05/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 100131240B | SOONERCARE | OK |
| 05 | — | 100131240B | — | OK |