Provider Demographics
NPI:1902016397
Name:WAYNE, SIGRID (MD)
Entity Type:Individual
Prefix:
First Name:SIGRID
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 E 51ST ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6231
Mailing Address - Country:US
Mailing Address - Phone:918-742-1478
Mailing Address - Fax:
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-742-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7793207ZP0102X
OK26197207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology