Healthcare Provider Details

I. General information

NPI: 1205836061
Provider Name (Legal Business Name): THOMAS SEYMOUR HENRY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 2 BOX 247 BLACK HAWK HEALTH CENTER
STROUD OK
74079
US

IV. Provider business mailing address

401 N BEARD ST
SHAWNEE OK
74801-6715
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-9531
  • Fax: 918-968-1532
Mailing address:
  • Phone: 405-273-0500
  • Fax: 405-273-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number99
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: