Organization
LESA J BETHEL MULLIGAN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANN M HOPKINS (INSURANCE COORDINATOR)
(405) 364-0643
Entity
Organization
Contact information
Practice address
1139 36TH AVE NW STE 100, NORMAN, OK 73072-4104
(405) 364-0643
(405) 364-0502
Mailing address
1139 36TH AVE NW STE 100, NORMAN, OK 73072-4104
(405) 364-0643
(405) 364-0502
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100131240B
SOONERCARE
OK
05
—
100131240B
—
OK
Enumeration date
03/15/2007
Last updated
05/23/2025
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