Healthcare Provider Details

I. General information

NPI: 1265490460
Provider Name (Legal Business Name): DAVID BRENT TIPTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 S WESTERN AVE
OKLAHOMA CITY OK
73109-3410
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5356
  • Fax: 405-636-7946
Mailing address:
  • Phone: 405-644-5356
  • Fax: 405-636-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18762
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: