Provider Demographics
NPI:1922350719
Name:ALLERGY ARTS OF OKLAHOMA PLLC
Entity Type:Organization
Organization Name:ALLERGY ARTS OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LIPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-760-7721
Mailing Address - Street 1:3300 NW 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4538
Mailing Address - Country:US
Mailing Address - Phone:405-760-7721
Mailing Address - Fax:405-212-4885
Practice Address - Street 1:3300 NW 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4538
Practice Address - Country:US
Practice Address - Phone:405-760-7721
Practice Address - Fax:405-212-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207K00261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101520AMedicaid
OK100101520AMedicaid