Individual
LESA JEAN BETHEL MULLIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1139 36TH AVE NW, NORMAN, OK 73072-4103
(405) 364-0643
(405) 364-0502
Mailing address
1139 36TH AVE NW, NORMAN, OK 73072-4103
(405) 364-0643
(405) 364-0502
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
18183
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100131240A
—
OK
01
—
100131240B
SOONERCARE
OK
Enumeration date
04/12/2006
Last updated
10/14/2021
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