Provider Demographics
NPI:1265461016
Name:IMHOFF, LYNNE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:H
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701074
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1074
Mailing Address - Country:US
Mailing Address - Phone:918-742-2502
Mailing Address - Fax:918-745-9750
Practice Address - Street 1:4415 S HARVARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2620
Practice Address - Country:US
Practice Address - Phone:918-742-2502
Practice Address - Fax:918-745-9750
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13167207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095350AMedicaid
248427401Medicare ID - Type Unspecified
OK243634010Medicare PIN