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General NPI Number Information
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NPI Number | 1710925680
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Entity Type | Individual
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Provider Name | MICKEY R TYRRELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 803 N FOREMAN ST SUITE 102
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City | VINITA
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State | OK
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Zip | 74301-1412
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Country | US
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Telephone | 918-256-2261
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Fax | 918-256-2304
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Provider Business Mailing Address
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Address Line | 803 N FOREMAN ST SUITE 102
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City | VINITA
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State | OK
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Zip | 74301-1412
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Country | US
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Telephone | 918-256-2261
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Fax | 918-256-2304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22897
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License Number State | OK
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