Healthcare Provider Details

I. General information

NPI: 1417214826
Provider Name (Legal Business Name): CODY ALLEN THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 STANTON L YOUNG BLVD # 451
OKLAHOMA CITY OK
73104-5020
US

IV. Provider business mailing address

940 STANTON L YOUNG BLVD # 451
OKLAHOMA CITY OK
73104-5020
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2422
  • Fax: 405-271-2568
Mailing address:
  • Phone: 405-271-2422
  • Fax: 405-271-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number33533
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: