Healthcare Provider Details

I. General information

NPI: 1891162467
Provider Name (Legal Business Name): TIMOTHY JAMES HERD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2015
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

4305 N HAMMOND AVE
BETHANY OK
73008-2921
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5437
  • Fax:
Mailing address:
  • Phone: 503-830-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41326
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: