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General NPI Number Information
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NPI Number | 1831533421
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Entity Type | Organization
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Legal Business Name | CHARLES D. VAN TUYL, PH.D., M.D.
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 201 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74128-1805
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Country | US
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Telephone | 918-492-6333
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Fax | 918-493-9405
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Provider Business Mailing Address
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Address Line | 6966 SOUTH UTICA SUITE 225
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City | TULSA
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State | OK
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Zip | 74136-3903
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Country | US
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Telephone | 918-492-6333
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Fax | 918-493-9405
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Authorized Official
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Title or Position | DR.
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Name | MR. CHARLES D VANTUYL
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Credential | PH.D., M.D.
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Telephone | 918-492-6333
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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 | 16535
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License Number State | OK
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