Provider Demographics
NPI:1689729907
Name:TRANSFORMING LIVES PLLC
Entity Type:Organization
Organization Name:TRANSFORMING LIVES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-359-2475
Mailing Address - Street 1:1800 RENAISSANCE BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3023
Mailing Address - Country:US
Mailing Address - Phone:405-359-2468
Mailing Address - Fax:405-359-2493
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-359-2475
Practice Address - Fax:405-341-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty