Provider Demographics
NPI:1184047953
Name:ALLURE MEDICAL SPA OF OKLAHOMA, LLC
Entity type:Organization
Organization Name:ALLURE MEDICAL SPA OF OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-523-0002
Mailing Address - Street 1:6711 S YALE AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3313
Mailing Address - Country:US
Mailing Address - Phone:918-359-5940
Mailing Address - Fax:918-359-5941
Practice Address - Street 1:4700 W URBANA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5997
Practice Address - Country:US
Practice Address - Phone:918-237-8346
Practice Address - Fax:918-359-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty