Provider Demographics
NPI:1912198375
Name:ATKINS, LADD CLAYTON (DO)
Entity Type:Individual
Prefix:DR
First Name:LADD
Middle Name:CLAYTON
Last Name:ATKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 E 102ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7061
Mailing Address - Country:US
Mailing Address - Phone:918-298-8080
Mailing Address - Fax:918-528-3841
Practice Address - Street 1:6304 E 102ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7061
Practice Address - Country:US
Practice Address - Phone:918-298-8080
Practice Address - Fax:918-528-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4362174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243729206Medicare PIN