Healthcare Provider Details

I. General information

NPI: 1447453071
Provider Name (Legal Business Name): TYSON QUY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2007
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 W MEMORIAL RD STE 135
OKLAHOMA CITY OK
73134-1787
US

IV. Provider business mailing address

4401 W MEMORIAL RD STE 135
OKLAHOMA CITY OK
73134-1787
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-1344
  • Fax: 405-849-4934
Mailing address:
  • Phone: 405-286-1344
  • Fax: 405-849-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25749
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25749
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: