Healthcare Provider Details

I. General information

NPI: 1437125218
Provider Name (Legal Business Name): GREGORY ANDREW TICHENOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GREG TICHENOR MD

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL PKWY
BEDFORD TX
76022-6913
US

IV. Provider business mailing address

P O BOX 960046
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 817-848-4000
  • Fax:
Mailing address:
  • Phone: 877-485-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ9391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: