Healthcare Provider Details

I. General information

NPI: 1407288756
Provider Name (Legal Business Name): TYRONE PHILIPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N MONTE VISTA ST
ADA OK
74820-4610
US

IV. Provider business mailing address

430 N MONTE VISTA ST
ADA OK
74820-4610
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-1127
  • Fax: 580-436-6674
Mailing address:
  • Phone: 580-421-1127
  • Fax: 580-436-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number137903
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6259
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31793
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: