Healthcare Provider Details

I. General information

NPI: 1104427897
Provider Name (Legal Business Name): CODY TYSON WHATLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N STONEWALL AVE
OKLAHOMA CITY OK
73117-2819
US

IV. Provider business mailing address

900 N STONEWALL AVE
OKLAHOMA CITY OK
73117-2819
US

V. Phone/Fax

Practice location:
  • Phone: 973-532-2096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: