Individual
MRS. LONI DAWN PEARISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1111 S SAINT LOUIS AVE, TULSA, OK 74120-5440
(918) 619-4600
Mailing address
13163 S OAK ST, GLENPOOL, OK 74033-2323
(918) 291-2022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5108
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200345220B
—
OK
05
—
200468380C
—
OK
Enumeration date
04/15/2010
Last updated
04/16/2014
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