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General NPI Number Information
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NPI Number | 1730277591
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Entity Type | Organization
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Legal Business Name | TED R ANDRESS DPM INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5930 E 31ST ST #300
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City | TULSA
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State | OK
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Zip | 74135-5114
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Country | US
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Telephone | 918-622-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 10024 S 106TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74133-5115
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Country | US
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Telephone | 918-381-7075
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TED R ANDRESS
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Credential | DPM
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Telephone | 918-381-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 100
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License Number State | OK
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