Provider Demographics
NPI:1184271793
Name:HEALTHY SKIN DERMATOLOGY OF OKLAHOMA PLLC
Entity type:Organization
Organization Name:HEALTHY SKIN DERMATOLOGY OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FARLEY
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-673-4980
Mailing Address - Street 1:13933 TECHNOLOGY DR STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1053
Mailing Address - Country:US
Mailing Address - Phone:405-673-4980
Mailing Address - Fax:847-787-1484
Practice Address - Street 1:13933 TECHNOLOGY DR STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1053
Practice Address - Country:US
Practice Address - Phone:405-673-4980
Practice Address - Fax:847-787-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty