Individual
DR. LEROY SOUTHMAYD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1202 W WILSHIRE BLVD, OKLAHOMA CITY, OK 73116-6109
(405) 823-3073
Mailing address
1202 W WILSHIRE BLVD, OKLAHOMA CITY, OK 73116-6109
(405) 823-3073
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
17164
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100219420B
—
OK
Enumeration date
03/23/2006
Last updated
03/08/2020
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