MEDICARE: ROY W BANKHEAD MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1073146304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY W BANKHEAD MD PC

Provider Business Mailing Address
First Line	:	5700 N PORTLAND AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1662
Country	:	US
Telephone Number	:	405-843-5855
Fax Number	:	405-843-5865

Provider Business Practice Location Address
First Line	:	5700 N PORTLAND AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1662
Country	:	US
Telephone Number	:	405-458-7162
Fax Number	:	405-384-7128

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ROY WARREN BANKHEAD
Credential	:	MD
Telephone Number	:	405-474-1479

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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