Organization
TULSA DERMATOLOGY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE J GREGG M.D. (PRESIDENT)
(918) 749-2261
Entity
Organization
Contact information
Practice address
2121 E 21ST ST, TULSA, OK 74114-1409
(918) 749-2261
(918) 749-8712
Mailing address
PO BOX 52588, TULSA, OK 74152-0588
(918) 749-2261
(918) 749-8712
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100729380A
—
OK
Enumeration date
07/15/2006
Last updated
05/16/2008
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