Healthcare Provider Details

I. General information

NPI: 1417867722
Provider Name (Legal Business Name): TIMOTHY D SIEGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 N REDMOND AVE
BETHANY OK
73008-5961
US

IV. Provider business mailing address

2205 N REDMOND AVE
BETHANY OK
73008-5961
US

V. Phone/Fax

Practice location:
  • Phone: 405-989-6740
  • Fax:
Mailing address:
  • Phone: 405-989-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: