Provider Demographics
NPI:1235208042
Name:DULLYE, LARRY J (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:DULLYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:802 S JACKSON AVE
Mailing Address - Street 2:200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9015
Mailing Address - Country:US
Mailing Address - Phone:918-585-3372
Mailing Address - Fax:918-599-9116
Practice Address - Street 1:802 S JACKSON AVE
Practice Address - Street 2:200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9015
Practice Address - Country:US
Practice Address - Phone:918-585-3372
Practice Address - Fax:918-599-9116
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1569208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100159680AMedicaid
OKE09827Medicare UPIN