SOUTHSIDE DERMATOLOGY PLLC (NPI# 1750877072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750877072 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE DERMATOLOGY PLLC |
| Practice Address |
5801 E 41st St Ste 200 Tulsa OK 74135 |
| Mailing Address |
6966 S Utica Ave Ste 225 Tulsa OK 74136-3903 |
| Practice Telephone | 9187600700 |
| Mailing Telephone | 9187600700 |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2018-10-10 |
| Authorized Official Name | ROBERT FISCHER (PRESIDENT) |
| Authorized Official Telephone | 9187600700 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5801 E 41st St Ste 200, Tulsa, OK 74135 | 9187600700 |
| Street Address |
5801 E 41ST ST STE 200 |
| City | TULSA |
| State | OK |
| Zip Code | 74135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225266307 | Alison Fischer | Dermatology | 5801 E 41st St Ste 200, Tulsa, OK 74135-5627 | 2009-06-26 |
| 1205440963 | Osu Center for Health Sciences | Clinic/Center | 5801 E 41st St Ste 200, Tulsa, OK 74135-5627 | 2020-09-01 |
| 1023378759 | Robert Fischer | Dermatology | 5801 E 41st St Ste 200, Tulsa, OK 74135-5627 | 2012-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1942839089 | Kimberly Renee Gillens | Student in an Organized Health Care Education/Training Program | 4502 E 41st Street Obgyn Department, Tulsa, OK 74135 | 2020-04-01 |
| 1528525524 | Everest Pain Management | Clinic/Center | 4134 S Harvard Ave Suite B1, Tulsa, OK 74135 | 2019-02-26 |
| 1326524216 | Shelley Deeann Anderson | Technician | 7359 S 68th, Tulsa, OK 74135 | 2018-07-14 |
| 1811489065 | Taylor Diane Spears | Behavioral Analyst | 4835 S Fulton Ave Suite 104, Tulsa, OK 74135 | 2018-06-04 |
| 1225547821 | Heather Nicole Freed | Counselor | 4363 S Harvard Ave, Tulsa, OK 74135 | 2017-09-26 |
| 1306363924 | Danielle Walker | Case Manager/Care Coordinator | 3244 S Lakewood Ave Apt 4e, Tulsa, OK 74135 | 2017-08-24 |
| 1346766078 | Angels Place | Day Training, Developmentally Disabled Services | 3919 S. Oswego Avenue, Tulsa, OK 74135 | 2017-08-15 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| 1346774197 | Brandie Herren | Registered Nurse | 6333 E Skelly Drive, Tulsa, OK 74135 | 2017-04-19 |
| Find all providers in zip 74135 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801320106 | Epiphany Dermatology of Oklahoma, LLC | Dermatology | 6717 South Yale Avenue, Suite 101, Tulsa, OK 74136-3318 | 2017-04-13 |
| 1225266307 | Alison Fischer | Dermatology | 5801 E 41st St Ste 200, Tulsa, OK 74135-5627 | 2009-06-26 |
| 1053450957 | Tracy D Kuykendall | Dermatology | 10115 E 80th St, Tulsa, OK 74133-3416 | 2007-02-06 |
| 1467538843 | Glenn Pete Dosser | Dermatology | 6465 S Yale, # 522, Tulsa, OK 74136 | 2006-10-28 |
| 1336163724 | Dermatology Associates of Tulsa LLC | Dermatology | 8803 S 101st E Ave, Ste 335, Tulsa, OK 74133-7550 | 2006-07-27 |
| 1710900097 | Steven A. Smith, M.d., Dermatology, P.C. | Dermatology | 9940 E 81st Street, Tulsa, OK 74133-4501 | 2006-07-26 |
| 1831121565 | Douglas M. Vaughn | Dermatology | 3915 E 51st St, Tulsa, OK 74135-3605 | 2006-07-06 |
| 1497713671 | Earl Udo Bachenberg | Dermatology | 1844 E 15th St, Tulsa, OK 74104-4611 | 2006-05-03 |
| 1629057690 | Steven Smith | Dermatology | 9940 E 81st St, Tulsa, OK 74133-4501 | 2006-01-10 |
| 1932195815 | Mark D Lehman | Dermatology | 2121 E 21st St, Tulsa, OK 74114-1409 | 2005-09-26 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.