Provider Demographics
NPI:1184982423
Name:UPTON, LEAH (DO)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:UPTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W MAIN ST SUITE S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3553
Mailing Address - Country:US
Mailing Address - Phone:918-299-9447
Mailing Address - Fax:918-299-5325
Practice Address - Street 1:11511 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-1908
Practice Address - Country:US
Practice Address - Phone:918-400-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine