Healthcare Provider Details

I. General information

NPI: 1821195942
Provider Name (Legal Business Name): ROGER WHITNEY TIMM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROGER WHITNEY TIMM PA-C

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax:
Mailing address:
  • Phone: 405-270-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1027
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: