Provider Demographics
NPI:1073621413
Name:ROLLINGS, LEA V (DO)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:V
Last Name:ROLLINGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:L
Other - Last Name:ROLLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3723 S EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3620
Mailing Address - Country:US
Mailing Address - Phone:918-688-3188
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-599-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3694207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100848020AMedicaid