Provider Demographics
NPI:1245280312
Name:FLECKENSTEIN, JAMES LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:FLECKENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11436 S LOUISVILLE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1647
Mailing Address - Country:US
Mailing Address - Phone:918-523-7226
Mailing Address - Fax:918-518-5136
Practice Address - Street 1:11436 S LOUISVILLE PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1647
Practice Address - Country:US
Practice Address - Phone:918-523-7226
Practice Address - Fax:918-518-5136
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK232882085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200014870AMedicaid
OKB95647Medicare UPIN
OKOKA102239Medicare PIN