MEDICARE: TABITHA D DANLEY D.O.

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	207Q00000X	Family Medicine Physician	4025	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467568097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA D DANLEY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 269064
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9064
Country	:	US
Telephone Number	:	405-272-5555
Fax Number	:	405-272-5517

Provider Business Practice Location Address
First Line	:	6201 N SANTA FE AVE
Second Line	:	SUITE 2010
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7538
Country	:	US
Telephone Number	:	405-272-5555
Fax Number	:	405-272-5517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/21/2020

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