Organization
BREAST SURGERY OF TULSA P L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANETTE F SMITH MD (OWNER)
(918) 299-8232
Entity
Organization
Contact information
Practice address
1120 S UTICA AVE, STE G200, TULSA, OK 74104-4012
(918) 299-8232
Mailing address
PO BOX 21228, DEPT 229, TULSA, OK 74121-1228
(918) 299-8232
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749120A
—
OK
Enumeration date
08/20/2006
Last updated
07/23/2007
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