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General NPI Number Information
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NPI Number | 1366616526
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Entity Type | Organization
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Legal Business Name | WILLIAM E TANKERSLEY MD PLLC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 604 S CLASSEN AVE SUITE C
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City | MOORE
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State | OK
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Zip | 73160-5401
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Country | US
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Telephone | 405-799-0900
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Fax | 405-799-0902
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Provider Business Mailing Address
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Address Line | PO BOX 7411
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City | MOORE
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State | OK
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Zip | 73153-1411
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Country | US
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Telephone | 405-799-0900
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Fax | 405-799-0902
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | WILLIAM E TANKERSLEY IV
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Credential | MD
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Telephone | 405-799-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 24016
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License Number State | OK
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