Provider Demographics
NPI:1790729150
Name:D'SOUZA, LIPHARD O (MD)
Entity Type:Individual
Prefix:
First Name:LIPHARD
Middle Name:O
Last Name:D'SOUZA
Suffix:
Gender:M
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 701353
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1353
Mailing Address - Country:US
Mailing Address - Phone:918-296-0596
Mailing Address - Fax:
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-296-0596
Practice Address - Fax:918-296-0596
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK151582084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100379610BMedicaid
IA0599597Medicaid
OK100008970AMedicaid
OK100008970BMedicaid
IA0599597Medicaid
OK100008970BMedicaid