Provider Demographics
NPI:1578665220
Name:LINDSEY, PHILLIP HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HARRIS
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14417 BUTTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2416
Mailing Address - Country:US
Mailing Address - Phone:405-751-3646
Mailing Address - Fax:405-751-3646
Practice Address - Street 1:716 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2118
Practice Address - Country:US
Practice Address - Phone:405-494-1915
Practice Address - Fax:405-751-3646
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK132442083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D-34945Medicare UPIN