Provider Demographics
NPI:1114987633
Name:OKLAHOMA CITY GYNECOLOGY AND OBSTETRICS, LLC
Entity Type:Organization
Organization Name:OKLAHOMA CITY GYNECOLOGY AND OBSTETRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LORRIANE
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-936-1000
Mailing Address - Street 1:PO BOX 8385
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8300
Mailing Address - Country:US
Mailing Address - Phone:405-936-1000
Mailing Address - Fax:405-936-1001
Practice Address - Street 1:11200 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5045
Practice Address - Country:US
Practice Address - Phone:405-936-1000
Practice Address - Fax:405-936-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100739550AMedicaid
OK100739550AMedicaid
OK400522435Medicare PIN