Provider Demographics
NPI:1104268903
Name:LINDA J TRUITT MD INC
Entity type:Organization
Organization Name:LINDA J TRUITT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-943-1114
Mailing Address - Street 1:5622 N PORTLAND AVE
Mailing Address - Street 2:101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2096
Mailing Address - Country:US
Mailing Address - Phone:405-943-1114
Mailing Address - Fax:405-943-1661
Practice Address - Street 1:5622 N PORTLAND AVE
Practice Address - Street 2:101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2096
Practice Address - Country:US
Practice Address - Phone:405-943-1114
Practice Address - Fax:405-943-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17676207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113010AMedicaid