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NPI Code Detail

MEDICARE: DAVID TILLER MD

MEDICARE: DAVID TILLER MD
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
12084F0202XForensic Psychiatry Physician26522OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00115455OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MDG232OTHERPREFERRED CARE
2P010204490OTHERBLUE CHOICE

General Provider Information

NPI Number : 1336155373
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID TILLER MD
Provider Business Mailing Address
First Line : 5300 N INDEPENDENCE AVE
Second Line : SUITE 280
City : OKLAHOMA CITY
State : OK
Zip : 73112-5556
Country : US
Telephone Number : 405-427-2441
Fax Number : 405-427-4741
Provider Business Practice Location Address
First Line : 2601 SPENCER RD
Second Line :
City : SPENCER
State : OK
Zip : 73084-3649
Country : US
Telephone Number : 405-427-2441
Fax Number : 405-427-4741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 09/30/2014

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