Healthcare Provider Details

I. General information

NPI: 1679548572
Provider Name (Legal Business Name): TIMOTHY J ELDRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 6200
OKLAHOMA CITY OK
73102-1017
US

IV. Provider business mailing address

401 SW 80TH ST STE 101
OKLAHOMA CITY OK
73139-8123
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-4211
  • Fax: 405-232-3767
Mailing address:
  • Phone: 405-286-9465
  • Fax: 405-286-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: