# OTTWELL DERMATOLOGY PLLC

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

## Provider details

- **NPI number:** 1700671492
- **Authorized official:** DR. RYAN LUCAS OTTWELL DO (OWNER)
- **Authorized official phone:** (918) 991-8718

## Contact information

- **Practice address:** 3915 E 51ST ST, TULSA, OK 74135-3605
- **Practice address phone:** (918) 991-8718
- **Mailing address:** 6224 S 223RD EAST AVE, BROKEN ARROW, OK 74014-2029
- **Mailing address phone:** (918) 991-8718

## Taxonomy

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

## Other

- **Enumeration date:** 04/12/2025
- **Last updated:** 04/12/2025