Healthcare Provider Details

I. General information

NPI: 1700292356
Provider Name (Legal Business Name): TAYYABA ALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

900 E MAIN ST
NORMAN OK
73071-5305
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4219
  • Fax:
Mailing address:
  • Phone: 405-573-6602
  • Fax: 405-573-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30640
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30640
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: