Provider Demographics
NPI:1265434997
Name:HARRIS, LAURANNE (MD)
Entity type:Individual
Prefix:
First Name:LAURANNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 N PORTLAND
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-949-6420
Mailing Address - Fax:405-949-6413
Practice Address - Street 1:5701 N PORTLAND
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-949-6420
Practice Address - Fax:405-949-6413
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16550207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100031600AMedicaid
160014970OtherRAILROAD MEDICARE
OK16550OtherSTATE MEDICAL LICENSE
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