Individual
WAYNE N LEIMBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1265 S UTICA AVE, SUITE 300, TULSA, OK 74104-4243
(918) 592-0999
(918) 592-1021
Mailing address
9228 S MINGO RD, SUITE 200, TULSA, OK 74133-5718
(918) 592-0999
(918) 878-2499
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
15626
OK
207RI0011X
Interventional Cardiology Physician
Primary
15626
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060007755
MEDICARE RAILROAD
OK
05
—
100055940A
—
OK
01
—
OK400771
MEDICARE PTAN
OK
01
—
P00611409
MEDICARE RAILROAD
OK
Enumeration date
01/24/2006
Last updated
02/19/2014
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