Provider Demographics
NPI:1861465916
Name:WIENS, LYNN ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ALLAN
Last Name:WIENS
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 1:6160 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1930
Mailing Address - Country:US
Mailing Address - Phone:918-495-2636
Mailing Address - Fax:918-495-2609
Practice Address - Street 1:6160 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1930
Practice Address - Country:US
Practice Address - Phone:918-495-2636
Practice Address - Fax:918-495-2609
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27391207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200263500AMedicaid
F27193Medicare UPIN