Healthcare Provider Details

I. General information

NPI: 1275672123
Provider Name (Legal Business Name): TIMOTHY MICHAEL GEIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N. WESTERN AVE. STE. 301
OKLAHOMA CITY OK
73114
US

IV. Provider business mailing address

3400 W TECUMSEH RD SUITE 101
NORMAN OK
73072-1810
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-7111
  • Fax: 405-478-7112
Mailing address:
  • Phone: 405-360-6764
  • Fax: 405-360-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number22888
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: