Provider Demographics
NPI:1508063074
Name:DORSEY, KIP WESTON (MD)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:WESTON
Last Name:DORSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:800 W BOISE CIR
Mailing Address - Street 2:STE 250
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4954
Mailing Address - Country:US
Mailing Address - Phone:918-744-3652
Mailing Address - Fax:918-744-3651
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3652
Practice Address - Fax:918-744-3651
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-06-07
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Provider Licenses
StateLicense IDTaxonomies
OK25838208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery