Provider Demographics
NPI:1356873277
Name:FORD, LINSEA DIANE (DO)
Entity type:Individual
Prefix:DR
First Name:LINSEA
Middle Name:DIANE
Last Name:FORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LINSEA
Other - Middle Name:DIANE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1705 E 19TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5410
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:918-403-6352
Practice Address - Street 1:1705 E 19TH ST STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5410
Practice Address - Country:US
Practice Address - Phone:918-748-7585
Practice Address - Fax:918-403-6352
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine