Provider Demographics
NPI:1225320328
Name:MATTOCKS, CLAIRE LUKEMAN (DO)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:LUKEMAN
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:LUKEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2000 S WHEELING AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5649
Mailing Address - Country:US
Mailing Address - Phone:918-906-9414
Mailing Address - Fax:918-747-3952
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5649
Practice Address - Country:US
Practice Address - Phone:918-906-9414
Practice Address - Fax:918-747-3952
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5248208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200477960AMedicaid